Acute Myeloid Leukemia (AML)

Acute Myeloid Leukemia (AML)

# Mechanism of Symptom Manifestation

AML causes symptoms due to the overwhelming presence of blast cells (immature cells) in the bone marrow and peripheral blood, leading to:

• Bone Marrow Suppression: Inhibition of red blood cell, white blood cell, and platelet production, resulting in anemia, leukopenia, and thrombocytopenia.

• Infiltration: Blast cells infiltrate other organs like the liver, spleen, lymph nodes, causing hepatomegaly, splenomegaly, enlarged lymph nodes, and flat bone pain.

# Blast Percentage in Bone Marrow

The blast percentage in bone marrow is typically > 30%.

# Characteristics of Anemia

Anemia in AML is usually normocytic (anemia due to reduced red blood cell count, but the size and color of red blood cells remain normal) and severe from the outset.

# Differentiating L-AML from Myeloid AML

• L-AML: PAS (+), Sudan black (-), Peroxidase (-)

• Myeloid AML: No such characteristics.

# Diagnosis

AML diagnosis is based on the criteria of the FAB (French-American-British) classification (1982).

# Treatment Principles

• Maximum Tolerated Dose Chemotherapy: Using strong chemotherapy drugs to eliminate acute leukemia cells.

• Combination of Strong Chemotherapy Drugs Targeting Different Stages of Cell Cycle: Using various chemotherapies that affect different stages of the cell cycle to increase the effectiveness of cell killing.

• Combined Attack, Consolidation, Maintenance, and Systemic Treatment: Combining treatment stages of attack, consolidation, maintenance, and system to control the disease.

• Symptomatic Treatment, Prophylaxis of Complications, and General Health Support: Managing associated symptoms, preventing complications, and supporting the patient’s overall health.

# Treatment Regimens

• Myeloid AML: 3+7 attack regimen

• Chemotherapy:

• Daunorubicin 30-45 mg/m2/d, intravenous infusion for 3 days

• Cytarabine 100 mg/m2/d, intravenous infusion for 7 days

• L-AML: VP attack regimen

• Chemotherapy:

• Vincristine 1.5-2 mg/m2/d, intravenous infusion once a week (usually stabilizes after 4 weeks)

• Prednisolone 60 mg/m2/d, oral daily

# Spinal Tap

Spinal tap with Methotrexate 10mg in week 2 and week 4.

# Maintenance RBC

Maintaining RBC (red blood cell) count > 90.

# Platelet Transfusion

Platelet transfusion when platelet count < 20 or severe bleeding occurs.

# Granulocyte Colony-Stimulating Factor

Using G-CSF if granulocyte count < 0.5.

# Complete Remission Assessment

• No Symptoms: Absence of disease symptoms.

• Blood Tests (BT): No leukemia cells in blood, RBC > 100, Platelet > 100 (not due to blood transfusion).

• Bone Marrow: Blast < 5%.