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Acute Myeloid Leukemia PediatricMyeloid leukemia is a tumor that develops from hematopoietic cells. Cancer starts in the bone marrow and can then spread to the lymph nodes, spleen, liver, brain, or testicles. This disease is deadly, but it is successfully treated in experienced centers. Acute myeloid leukemia is a prognostically unfavorable disease. It can develop in an adult or child, but older people are more likely to get sick. The average age of the patient is 63 years. The older the person, the higher the risk of developing pathology. The age is also an unfavorable prognostic factor that reduces the success of treatment.
Symptoms
Acute myelogenous leukemia usually does not have specific symptoms, for which this disease could be suspected. However, the developing non-specific signs of the pathological process in the patient usually become the reason for going to the doctor. In the clinic, he will undergo blood tests, and with them the doctor can detect changes characteristic of myeloid leukemia.
The main symptoms of the disease are:
Due to the impaired bone marrow function, the amount of normal blood cells in the blood decreases over time: red blood cells, white blood cells and platelets. They are responsible respectively for oxygen transport, immunity and blood coagulation. Depending on which disorders prevail, additional symptoms may develop:
A large number of pathologically altered too large white blood cells accumulate in the blood. They do not ensure the functioning of the immune system but can clog important vessels. This phenomenon is called leukostasis. It develops at a blast cell concentration of 100 thousand in 1 mcl. The result may be shortness of breath, blurred vision, weakness on one side of the body, drowsiness. Such symptoms require emergency medical care. Most of them are associated with oxygen starvation of brain regions.
Other possible symptoms:
Although there is no screening for acute myelogenous leukemia, its symptoms manifest themselves quite early. A visit to the doctor at the first signs of a serious pathology is the best way to diagnose myeloid leukemia early.
A periodic undergoing of a complete blood count is indicated without the occurrence of any symptoms only to patients at risk for myeloid leukemia. These include:
Although in this category of patients the risk of disease is higher, most of them do not develop myeloid leukemia.
Establishment of the diagnosis
In the diagnosis of acute myeloid leukemia, the main role is played by laboratory tests, rather than medical imaging methods, as with other malignant processes. The doctor begins by studying the medical history, conducting a physical examination of the patient. Regardless of the reason for the visit to the clinic, everyone is assigned a complete blood count at the initial appointment with the doctor. It can detect impairments. After this, a hematologist will be involved in further diagnostics.
Here are some basic procedures for confirming the diagnosis:
Typically, two samples can be obtained simultaneously. The biomaterial is mostly sampled from the pelvic bones, less often it can be obtained from the sternum.
Bone marrow aspiration is suction using a syringe. A biopsy is performed in the second stage. During the study, a thick needle is pressed into the bone. As a result, the doctor receives a column of the pelvic bone and bone marrow, which is subject to histological examination. The procedure can be performed both for the initial diagnostics of the disease, as well as for the further diagnostics for the assessment of the response to ongoing chemotherapy or for the identification of a relapse of the pathology.
Sometimes, liquor can be tested as well. This is rarely done, only if there are signs of damage to the central nervous system.
Changes in the tests
Leukemia can be detected using a routine blood test, whereas the subsequent bone marrow examination has only a clarifying value.
In myeloid leukemia, blood contains few red blood cells and platelets. There are many white blood cells, but they are inferior. These forms of white blood cells are called myeloblasts. They are immature white blood cells, and for this reason they are not able to perform the function of ensuring the normal work of the immune system.
The diagnosis is established through red bone marrow testing. It is considered confirmed if there are more than 20% blast cells in the sample. Normally, their levels should not exceed 5%, and they should be completely absent in the blood. If blast cell levels in the red bone marrow are more than normal, but less than 20%, the diagnosis can be established using genetic testing.
Additional diagnostic methods:
The clarifying tests allow the doctors to predict the further development of the disease and better plan treatment.
Although imaging methods are usually not required, some patients may undergo them. If the doctor suspects the presence of a tumor in some organ (spleen, liver, kidney, brain or lymph node), it should be detected.
The diagnostics is performed not only to establish a diagnosis, but also after treatment. The goal of therapy is to achieve remission. Complete remission is when the levels of blast cells in the bone marrow decrease to less than 5%. A molecular remission suggests the inability to detect signs of myeloid leukemia even using PCR (the most sensitive of all tests). With an increase in blast forms in the bone marrow to 5% or more, relapse is detected.
Treatment:
The mainstay treatment of acute myeloblastic leukemia is chemotherapy. This is usually carried out in three consecutive stages:
Induction is an intensive treatment that lasts about one week. The task of doctors is to cleanse the blood of excess leukocytes and reduce the number of blasts in the bone marrow to normal indicators.
Consolidation is carried out after achieving remission. This is aimed at destroying the remaining small number of pathological cells. Chemotherapy is conducted in cycles. Each cycle is followed by a rest period so that the body can recover and cancer cells become more susceptible to the action of chemotherapy drugs.
Maintenance is a type of treatment when oncologists use low doses of drugs for months or even years after the completion of consolidation. A maintenance step is not required for all patients. This is most commonly used for acute promyelocytic leukemia but is not usually needed for other types of acute myeloid leukemia.
Most chemotherapy drugs are given intravenously. Less commonly, pills or subcutaneous injections are used.
Doctors conduct intrathecal chemotherapy if there are signs of the spread of myeloid leukemia to the central nervous system. The drugs are injected into the lumbar region, into the cerebrospinal fluid.
Targeted therapy is used in addition to chemotherapy and sometimes as a standalone method if chemotherapy does not work.
In the case of myeloid leukemia, doctors use drugs that are neither chemotherapy nor targeted therapy.
All-trans retinoic acid (ATRA) is a form of vitamin A. This is included in the induction regimen, along with chemotherapy. The drug is safe and can also be used in the consolidation phase. Although the medication can sometimes cause side effects, patients' symptoms are not severe and resolve completely after therapy is completed.
Arsenic trioxide (ATO) can be used in the induction and consolidation phases, combined with ATRA, chemotherapy and targeted therapy. This affects the heart rhythm and therefore requires an ECG several times a week during the entire period of treatment.
Radiation therapy is rarely used for the treatment of myeloid leukemia. This is carried out only if clinically indicated:
In severe cases, doctors resort to a stem cell transplant. This procedure can be:
The essence of the treatment is that doctors prescribe high doses of chemotherapy agents, sometimes combined with total body irradiation, to destroy all cancer cells. The bone marrow is also destroyed along with them. A patient is subsequently injected with stem cells, his own or donor ones, to restore it.
An allogeneic transplant is predominantly used for the treatment of myeloid leukemia, since an autologous one usually does not completely cure this disease. The problem is that the patient's own bone marrow already contains cancer cells, and after the transplant procedure, they will cause the disease recurrence. At the same time, the transplantation from a donor, although more dangerous, helps a person to cure a severe onco-hematological disease once and for all.
The donor must be HLA (leukocyte antigen) compatible. It is better if it is a brother or a sister: the probability of a match is about 25%. If there is no suitable donor among the relatives, doctors will look for a suitable unrelated donor in their database. This may take several weeks or even months. The better the compatibility between the donor and the recipient, the greater the chance that stem cells will survive in the body and begin to perform a hematopoietic function.
If the transplantation is a success, an immune response "graft-versus-leukemia" develops. The renewed immunity better recognizes pathological cells and successfully attacks them.
However, this medal also has a downside. Some patients develop graft-versus-host disease. Their immunity begins to attack the body's own tissues, perceiving them as foreign. The better the compatibility of the donor and the recipient, the lower the risk of such complications. Nonetheless, even if such reactions develop, they can be controlled with drugs that suppress the immune system.
Doctors perform a mini-transplant procedure for older people who cannot tolerate a standard allogeneic transplant. This is also called non-myeloablative because high-dose chemotherapy does not completely suppress the bone marrow. After injecting donor stem cells, they exist for some time with the patient's own cells, but then they gradually replace them. The advantage of this approach is less toxicity of treatment. However, there is a risk that the donor cells will not survive in the bone marrow, so a mini transplant is considered not a standard, but an alternative method of stem cell transplant. This can be used only for those patients who cannot endure the usual procedure due to their poor health.
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The program includes:
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 6 days
______________________________________________________________________
The program includes:
Required documents
Price from: on request
Type of program: Inpatient or outpatient (related to your diagnosis and treatment protocol).
Expected duration of the program: may differ and be related to your diagnosis and treatment protocol.
__________________________________________________________________________
The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).
Radiation therapy is carried out as an inpatient procedure, with mandatory admission to the hospital. Before each session the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded radiation therapy room, on a special table.
Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will have from 1 to 3-5 sessions of radiation therapy a week.
After the completion of the radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 30 days
___________________________________________________________________________
The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan, CT scan and MRI. Also, the doctor will conduct a bone marrow biopsy followed by cytological examination of the harvested material. This will help him to determine the histological features of your bone marrow (in particular, identify HLA system antigens) and the use of a person’s own stem cells. They typically involve harvesting your cells before beginning a damaging therapy to cells like chemotherapy or radiation. After the treatment is done, your own cells are returned to your body.
This type of transplant isn’t always available. It can only be used if you have a healthy bone marrow. However, it reduces the risk of some serious complications, including GVHD.
Before the procedure, you will receive chemotherapy, if necessary, in combination with radiation therapy. The course of chemo- or chemoradiation therapy lasts from 2 to 8 days.
The bone marrow transplant procedure is an intravenous infusion, i.e. the healthy bone marrow will be injected through a catheter, intravenously. You will stay in your room during the procedure. A bone marrow transplant is completely painless and does not require anesthesia.
During the period of healthy bone marrow engraftment, you will stay in a sterile ward. This is a necessary precaution because during this time your immune system is very weak and cannot withstand environmental pathogens. The risk of bleeding is also quite high, so you will be advised to avoid mechanical damage.
A relative or other close person may stay in the ward with you. You will not be allowed to go outside the department and leave your ward often. The rehabilitation period can last from 1 to 2 months.
When your complete blood count returns to normal, your doctor will schedule your discharge from the department. You will receive information about the rules that you will need to follow at home, the frequency and type of control examinations, and subsequent treatment measures. You will also receive a detailed medical report, which will reflect the entire course of treatment.
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 57 days
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