Acute myelogenous leukaemia (AML)

Overview:

• AML is a potentially curable disease
• More common in older adults
• Is classified on the basis of the morphological appearance of the bone marrow into 7 subtypes (M1-M7), which differ by virtue of the predominant cell type involved

Treatment:

Treatment has traditionally been divided as being in 2 parts – remission induction (complete remission – CR) and post-remission/consolidation therapy. The reason for the continuation of therapy post-remission is as follows:

• At the point of CR (when there is no morphologically detectable leukaemia) there are still 10⁸ or10⁹ leukaemic blast cells present.
• It is, therefore, not surprising that if no post-remission therapy is given, the majority of patients develop recurrent leukaemia

Induction of remission is via chemotherapy:

• An anthracycline drug (e.g. doxorubicin) in conjunction with cytarabine, with or without another drug (e.g. etoposide)
• Patient needs to stay in hospital for 4 weeks in the first instance owing to the risk of infection and bleeding consequent upon neutropenia and thrombocytopenia
• Subsequent cycles of treatment are given on an outpatient basis

Options for post-remission therapy include:

• Further cycles of the same chemotherapy used to induce remission
• Chemotherapy different from that given to induce remission
• Myeloablative therapy with allogeneic/autologous bone marrow transplantation (BMT)

Prognosis:

• Approx. 70% of patients <60 years of age will return to normal health
• However, within 1-3 years the disease will recur in at least 60% (the remainder almost certainly having been cured
• In younger patients with a recurrence, cure is still possible for a proportion, using myeloablative therapy with allogeneic/autologous haemopoietic progenitor cell support (HPCS)