The acute myeloid leukemia is a hematological malignancy (blood cancer) that develops in the bone marrow, blood, the lymphatic system, and other tissues. Leukemias are commonly divided into acute and chronic, depending on the rate of disease progression.
Why does it happen and who is at risk?
In patients with acute myeloid leukemia, the bone marrow produces a large number of abnormal white blood cells, which present genetic mutations in the DNA and do not work correctly. The causes of this disease are not yet known precisely, but both genetic and environmental factors seem to be implicated.
Acute leukemia originates from the bone marrow, the site in which the immature blood cells reside and where these same cells reach maturity before leaving the bone marrow and entering the bloodstream. The term acute refers to the rapid progression of the disease.
When in the bone marrow some of these immature cells undergo serious genetic alterations, they begin to increase in an uncontrolled manner, often hindering the development of healthy cells. The onset of symptoms is very early, from the earliest stages of the beginning of the disease, so much so that in some cases it can be fatal if action is not taken quickly. Nevertheless, a good part of acute leukemias, especially in young subjects, can be cured and healed.
Acute myeloid leukemia most frequently affects adults, and its incidence increases proportionally with increasing age.
How is the diagnosis made?
To diagnose acute myeloid leukemia, blood tests and a bone marrow sample are required.
A diagnosis of AML is made when the number of leukemia cells is > 20% in the bone marrow.
The most important exams are –
Blood count and peripheral blood smear – It allows qualitative and quantitative estimation of white blood cells, platelets, and red blood cells.
Needle aspiration and bone marrow biopsy – Samples are taken through the first procedure to perform the morphological analysis (optical microscope reading of the cells present in the bone marrow), cytogenetics (examination of the number and structure of the chromosomes of bone marrow cells), immunophenotypic (analysis of the surface characteristics of leukemic cells) and molecular features (search for markers that allow prognostic framing and response monitoring). The bone marrow biopsy (BOM) consists of the extraction of a small cylinder of bone and is not always considered necessary.
How is it treated?
The choice of the most suitable therapy for AML depends on several factors – on the characteristics of the disease and the patient. Furthermore, it must be remembered that this disease tends to recur because it is difficult to eradicate the leukemic cells totally. This is why therapies can be prolonged, and there may be a need for transplant procedures.
In patients under the age of 70 who enjoy good general health condition, an intensive care course is generally dealt with based on chemotherapy cycles. The main objective of chemotherapy is to bring back to normal the number of leukemia cells present in the marrow and in the peripheral blood thus obtaining complete remission, i.e., the disappearance of leukemia cells from peripheral blood and their reduction in the marrow < 5%. The initial phase is called induction and consists of a cycle of chemotherapy followed by a phase of aplasia (i.e., very low blood values) with the hospitalization of about a month. However, complete remission does not mean healing or total elimination of the disease. A small number of leukemic cells not always identifiable even with the most advanced techniques, can persist and be the cause of recurrence. To enhance the benefits obtained from the first phase of therapy and to make continuous complete remission up to healing it is necessary to perform an additional 1-4 cycles of chemotherapy.
The cost of cancer therapy would consist of chemotherapy for about 6 cycles at about INR 2 lakhs per cycle or USD 2,800. There will also be the cost of hospitalization for 30-90 days which would vary depending on the type of hospital and may cost between INR 40,000 at state-run facilities to upwards of INR 4 lakhs at best private care hospitals or between USD 550 and 5,550. In case bone marrow transplant is needed it would require an additional INR 8-10 lakhs or USD 11,000. In all the cost may vary between INR 10 lakhs to 25 lakhs depending on the procedure and duration of therapy.