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Understanding acute myeloid leukemia

Acute myeloid leukemia (AML) is a rare disease that primarily affects the elderly. It is a cancer of the blood and bone marrow that can progress rapidly when left untreated.

Acute myeloid leukemia is the most common acute leukemia in adults and affects five out of 100,000 people living in Europe1. The five-year survival rate of AML patients over the age of 60 is less than 10%2.

In 2024 in the United States, over 20,000 new cases of AML were diagnosed and the disease caused more than 11,000 deaths3. AML accounts for 31% of all leukemias diagnosed in adults above the age of 204.

This cancer is characterized by a proliferation of immature cells, which are not sufficiently developed and therefore cannot function normally. Because these cancerous cells are present in the blood, the term “leukemia” is used; since they arise from myeloid blast, the term “myeloid” is also associated.

Bone marrow is the tissue present in the bones where these immature blood cells are produced.

How does AML develop?

AML occurs when there are changes in the DNA of a stem cell of the bone marrow during the development stage. The affected stem cell transforms into a leukemic cell and multiplies into millions of “leukemic blasts,” known as myeloblasts. These myeloblasts block the production of normal blood cells, both red and white, as well as platelets, the blood cells produced by bone marrow that play an important role in coagulation.

A grandfather with acute myeloid leukemia and his granddaughter

A decrease in blood cells can be detected through biological tests. One of the main effects observed in patients is neutropenia, i.e., a low level of white blood cells. As a result, the immune system, which usually protects the body from infections, grows weaker. Anemia, or a reduction in the number of red blood cells in the blood, can also be observed. Oftentimes, this results in asthenia (significant fatigue), as well as thrombocytopenia (an abnormal decrease in the number of platelets in the blood).

AML risk factors

For most patients with AML, there are no obvious causes of the disease, and the main one is rarely identified. Instead, risk factors can be present, such as repeated exposure to benzene (cigarette smoke, petroleum products, work environment using benzene). Other risk factors include certain genetic diseases such as Fanconi anemia or Down syndrome, some chemotherapy or radiotherapy, or the development of certain cancers and blood diseases. Sometimes, these various risk factors can alter the DNA of blood cells located in bone marrow.

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How AML is treated

The main treatment for AML is based on chemotherapy, which aims to eliminate cancerous cells.

In general, there are two treatment phases, an induction phase and a consolidation phase. The induction phase generally lasts one month and serves to eliminate most cancerous cells. Consolidation therapy, meanwhile, prevents relapse, i.e., the recurrence of cancerous cells. Chemotherapy may be combined with targeted therapies in order to prevent cancerous cells from developing. In certain cases, a stem cell transplant may be considered. During both treatment phases of AML, supportive care is provided to help the patient deal with the side effects of treatments and those caused by the disease.

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REMEMBER

  1. AML is a blood and bone marrow cancer that can develop rapidly if a patient does not receive treatment.
  2. For most people with AML, there is no obvious cause for the disease. AML cannot be contracted from someone else.
  3. A potential risk factor is repeated exposure to benzene (cigarette smoke), which damages the DNA of normal bone marrow cells.

[1] ESMO Guidelines 2020 – Acute myeloid leukemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up -https://www.annalsofoncology.org/article/S0923-7534(20)36079-8/fulltext – Annals of Oncology, consulté le 20/02/2025
[2] National Library of Medicine (NIH), Survival for older patients with acute myeloid leukemia: a population-based study, https://pmc.ncbi.nlm.nih.gov/articles/PMC3590098/ – consulté le 20/02/2025
[3] National Cancer Institute, Acute Myeloid Leukemia Treatment (PDQ®)–Health Professional Version, https://www.cancer.gov/types/leukemia/hp/adult-aml-treatment-pdq?#section_1.1 –consulté le 20/02/2025
[4] American Cancer Society, Cancer Facts & Figures 2024