(AML, acute non-lymphoblastic leukemia, acute myelogenous leukemia) is a malignant tumor of the myeloid blood lineage, in which altered white blood cells multiply rapidly. Accumulating in the bone marrow, they inhibit the growth of normal blood cells. AML is the most common type of acute leukemia in adults, and its incidence increases with age. Although acute myeloid leukemia is a relatively rare disease—accounting for only 1.2% of deaths in the United States—it is expected to increase in frequency as the population ages.
The symptoms of acute myeloid leukemia are caused by the replacement of normal bone marrow by leukemia cells, which leads to a decrease in the number of red blood cells, platelets, and normal white blood cells. The disease is manifested by rapid fatigue, shortness of breath, frequent minor skin lesions, increased bleeding, and frequent infections. The clear cause of the disease is still unknown, but some risk factors for its occurrence have been identified. Like any acute disease, AML develops quickly, and without treatment it becomes fatal in a few months, sometimes weeks.
There are several types of AML, treatment and prognosis for them are different. The five-year survival rate ranges between 15-70%, and the remission rate ranges from 78-33%, depending on the subtype of the disease. At the onset, AML is treated with chemotherapy to achieve remission; then maintenance chemotherapy or a hematopoietic stem cell transplant may be performed. Recent studies of AML at the genetic level have made it possible to develop tests that can be used to fairly accurately determine the likelihood of a patient's survival and the effectiveness of a particular drug for an individual case of AML.

Symptoms:

Most of the symptoms of AML are caused by the replacement of normal blood cells by leukemia cells. Insufficient formation of leukocytes makes the patient highly susceptible to infections - despite the fact that leukemic cells come from the precursors of leukocytes, they do not have the ability to resist infections. A low number of red blood cells (anemia) can cause fatigue, paleness, and shortness of breath. A lack of platelets can lead to easy skin irritation and increased bleeding. .
Early signs of AML are often vague and nonspecific, and may resemble those of other common diseases. Some common symptoms of AML include: fever, fatigue, weight loss or loss of appetite, increased skin and mucous membrane damage and bleeding, petechiae (flat, pinhead-sized spots inside the skin at the site of bleeding), bruises, bone and joint pain, and persistent or frequent infections.
In AML, there may be an enlargement of the spleen, but it is usually mild and asymptomatic. Enlarged lymph nodes in AML occur infrequently, unlike acute lymphoblastic leukemia. In 10% of cases, skin changes develop in the form of cutaneous leukemia. Occasionally, AML occurs, which is also inflammation of the skin around areas affected by chloroma.
Some patients with AML develop swollen gums due to tissue infiltration by leukemia cells. Occasionally, the first sign of leukemia is chloroma - a dense leukemic mass outside the bone marrow. Sometimes the disease is asymptomatic, and leukemia is detected by a general blood test during a routine examination.

Causes:

A number of factors have been identified that contribute to the occurrence of AML - other disorders of the hematopoietic system, exposure to harmful substances, ionizing radiation, and genetic influence.
Preleukemia.
“Preleukemic hematopoietic disorders, such as myeloproliferative syndrome, can lead to AML; the likelihood of the disease depends on the form of myelodysplastic or myeloproliferative syndrome.
Exposure to chemicals.
Antitumor chemotherapy, especially with alkylating agents, may increase the likelihood of subsequent AML. The highest incidence of disease occurs 3-5 years after chemotherapy. Other chemotherapy drugs, especially epipodophyllotoxins and anthracyclines, have also been associated with post-chemotherapy leukemias. Leukemias of this type are often explained by specific changes in the chromosomes of leukemic cells.
Occupational exposure to benzene and other aromatic organic solvents as a possible cause of AML remains controversial. Benzene and many of its derivatives exhibit carcinogenic properties in vitro. Some observational data support the possibility that occupational contact with these substances may influence the likelihood of developing AML, but other studies confirm that if such a danger exists, it is only an additional factor.
Ionizing radiation.
Exposure to ionizing radiation increases the likelihood of developing AML. Survivors of the atomic bombings of Hiroshima and Nagasaki have an increased incidence of AML, as do radiologists exposed to high doses of X-ray radiation at a time when radiological protection measures were insufficient.
Genetic factors.
There is probably a hereditary increased likelihood of developing AML. There are a large number of reports of many familial cases of AML, when the incidence exceeded the statistical average. The likelihood of AML occurring in the patient's immediate family is three times higher.
A number of congenital conditions can increase the likelihood of AML. Most often this is Down syndrome, in which the likelihood of AML is increased by 10 to 18 times.

Treatment:

Treatment of AML consists primarily of chemotherapy, and is divided into two stages: induction and post-remission treatment (or consolidation). The goal of induction therapy is to achieve complete remission by reducing the number of leukemia cells to undetectable levels; The goal of consolidative therapy is to eliminate residual disease remnants that are undetectable by modern methods and cure.
Induction.
For all AML subtypes except M3 according to the FAB classification, induction chemotherapy with cytarabine and an anthracycline (for example, daunorubicin or idarubicin) is usually used. This method of induction chemotherapy is known as “7 + 3” - due to the fact that cytarabine is administered intravenously by drip seven days in a row, and then three days in a row, vidarabine is injected in a daily dose. With this method of treatment, remission occurs in almost 70% of patients with AML. Other methods of induction treatment can be used, including monotherapy with high doses of cytarabine, or drugs that are at the research stage. Due to the toxic effects of treatment, including suppression of myeloid lineage and increased likelihood of infectious complications, induction chemotherapy is not offered to very old patients, and less intensive palliative chemotherapy is prescribed. Subtype M3 AML, also known as acute promyelocytic leukemia, is treated with the drug in almost all cases. ATRA (all-trans retinoic acid) in addition to induction therapy. When treating acute promyelocytic leukemia, it is necessary to take into account the possibility of developing disseminated intravascular coagulation syndrome due to the entry of the contents of promyelocyte granules into the peripheral blood. Treatment of acute promyelocytic leukemia is extremely effective, this has been reliably proven by many documented cases of treatment.
The goal of the induction phase of treatment is to achieve complete remission. Complete remission does not mean that the disease is completely cured. Rather, the state of complete remission indicates the impossibility of detecting the disease using existing diagnostic methods. Complete remission is achieved in 50-70% of adult patients with newly diagnosed AML, the difference depends on the prognostic factors mentioned above. The duration of remission depends on the prognostic qualities of the original leukemia. Basically, all cases of remission without additional, consolidating treatment result in relapse.
Consolidation treatment.
Even after complete remission is achieved, it is likely that few leukemia cells will still survive. There are so few of them that it is not yet possible to detect them. If post-remission or consolidation treatment is not carried out, almost all patients eventually experience a relapse. Therefore, in order to get rid of undetectable diseased cells and prevent relapse - that is, to achieve a complete cure, additional therapy is needed. The type of treatment after achieving remission is determined individually depending on prognostic factors and the general health of the patient. For prognostically favorable subtypes of leukemia (for example, inv(16), t(8;21) and t(15;17), 3-5 additional courses of intensive chemotherapy, known as consolidation treatment, are usually prescribed. Patients with a high risk of relapse (for example, In the presence of cytogenetic changes, concomitant myelodysplastic syndrome, or in AML associated with previous treatment, transplantation of allogeneic hematopoietic stem cells is usually recommended if the general condition allows and a suitable donor is available. For AML with an average likelihood of relapse (with normal cytogenetic parameters or with such cytogenetic parameters). changes that do not fall into risk groups), the issue of consolidation treatment is not so clear and is determined by a number of specific indicators - the age of the patient, his general health, value system, and finally, the presence of a donor of suitable stem cells.
Those patients for whom stem cell transplantation after consolidation treatment is not indicated are treated with immunotherapy with a combination of histamine hydrochloride (Zeplen) and proleukin. This treatment can reduce the likelihood of relapse by 14%, prolonging remission by 50%.
Thus, high-intensity chemotherapy (HIT) and bone marrow transplantation are recognized as the standard therapy for AML.
However, treatment results, despite relatively high responses in young people, remain unsatisfactory in people over 65 years of age (30-50%) associated with early mortality (10%) and short duration of remission. More than half of those with AML are older patients and/or with significant comorbidities who, as a rule, cannot receive highly toxic chemotherapy regimens, so they are treated with low doses of cytarabine and supportive treatment: antibiotics and blood transfusions.
Since 2010, the US has recommended the use of hypomethylating agents (5-azacytidine, decitabine) for the treatment of AML in patients who are not suitable for bone marrow transplantation/intensive chemotherapy. During DNA methylation, hypomethylating agents covalently bind to DNA methyltransferase, which leads to gene reactivation, after which differentiation of hematopoietic progenitor cells and normal hematopoiesis are restored. 5-azacytidine has a dual mechanism of action. It is integrated not only into the DNA molecule, but also into the RNA molecule. Thus, 5-azacytidine reduces the amount of RNA in cells, which leads to a cytostatic effect regardless of the cellular phase.
Based on the results of the phase 3 study AZA-001, an international, multicenter, controlled, parallel group study in which patients with high-risk MDS/AML (WHO criteria) were compared with standard of care therapy (adjuvant therapy, intensive chemotherapy, low-dose cytarabine), azacitidine was registered, including in the Russian Federation, for the treatment of these groups of patients. Azacitidine has been shown to increase overall survival of patients with AML by 2.5 times (WHO criteria).

Acute myeloid leukemia is a malignant tumor of the myeloid blood lineage. The disease is characterized by the rapid proliferation of altered white blood cells. Accumulating in the bone marrow, they inhibit the growth of normal blood cells, resulting in a decrease in the number of platelets, red blood cells, and normal leukocytes. The disease is manifested by rapid fatigue, frequent minor skin lesions, shortness of breath, frequent infections, and increased bleeding. It is the most common type of acute leukemia in adults, the incidence increases with age.

Causes

Factors contributing to the development of acute myeloid leukemia:

1. Pre-leukemia (myelodysplastic syndrome, myeloproliferative syndrome);

2. Exposure to chemicals (chemotherapeutic drugs, benzene, other aromatic organic solvents);

3. Ionizing radiation;

4. Genetic factors (the likelihood of the disease occurring in the patient’s immediate relatives is three times higher).

Symptoms of acute myeloid leukemia

An insufficient number of normal white blood cells causes high susceptibility to infections. Due to a decrease in the number of red blood cells, anemia develops, which can cause pallor, fatigue, and shortness of breath. A lack of platelets leads to easy skin damage and increased bleeding.

Early signs of the disease are often nonspecific and may resemble symptoms of the flu or other illnesses (fever, weight loss, loss of appetite, fatigue, shortness of breath, increased skin damage, bleeding, bruises, persistent or frequent infections, joint and bone pain). There may be an enlargement of the spleen and lymph nodes.

Some patients experience swelling of the gums due to tissue infiltration by leukemia cells.

The disease can be asymptomatic and is detected during a general blood test during a routine examination.

Diagnostics

A characteristic change in the ratio of cellular elements in a general blood test is an increase in the total number of leukocytes (leukocytosis), the appearance of immature (blast) forms, a decrease in platelets and red blood cells. A preliminary diagnosis can be determined by identifying blast forms of leukocytes in peripheral blood smears.

For a definitive diagnosis, appropriate changes in the bone marrow aspiration biopsy must be present.

In accordance with the WHO classification criteria, the diagnosis of acute myeloid leukemia is established if the presence of more than 20% myeloblast cells in the bone marrow and/or blood is proven.

Classification

M0 - minimally differentiated acute myeloblastic leukemia;

M1 - acute myeloblastic leukemia without maturation;

M2 - acute myeloblastic leukemia with maturation;

M3 - acute promyelocytic leukemia;

M4 - acute myelomonocytic leukemia;

M4eo - acute myelomonocytic leukemia with bone marrow eosinophilia;

M5 - acute monoblastic leukemia or acute monocytic leukemia;

M6 - acute erythroid leukemia, incl. acute erythroleukemia, very rare acute pure erythroid leukemia, acute mixed erythroleukemia, pure erythroid leukemia;

M7 - acute megakaryoblastic leukemia;

M8 - acute basophilic leukemia.

• myeloid sarcoma;
• acute eosinophilic leukemia;
• acute myeloid dendritic cell leukemia;
• acute mast cell leukemia;
• acute panmyelosis with myelofibrosis;
• acute basophilic leukemia

Patient Actions

If signs of the disease appear, you should consult a doctor.

Treatment of acute myeloid leukemia

Treatment of acute myeloid leukemia consists mainly of chemotherapy, which occurs in two stages: induction and post-mission treatment. The goal of induction therapy is to achieve complete remission by reducing the number of leukemia cells to a certain level.

Complications

The main complication of this disease is death. The causes of death in acute leukemia are hemorrhagic syndrome (DIC), neuroleukemia, renal failure, heart failure, acute adrenal failure, infectious complications (sepsis).

Prevention of acute myeloid leukemia

There is no specific prevention. For timely detection of the disease You must regularly visit your doctor and take all required laboratory tests. After completing treatment for acute leukemia, the patient should not move to places with different climatic conditions or subject their body to procedures related to physiotherapy.

Children who have recovered from leukemia receive preventive vaccinations in accordance with a specially developed schedule.

– a malignant disease of the blood system, accompanied by the uncontrolled proliferation of altered leukocytes, a decrease in the number of red blood cells, platelets and normal leukocytes. It is manifested by an increased tendency to develop infections, fever, fatigue, weight loss, anemia, bleeding, the formation of petechiae and hematomas, pain in bones and joints. Sometimes skin changes and swelling of the gums are detected. The diagnosis is made based on clinical symptoms and laboratory data. Treatment is chemotherapy, bone marrow transplantation.

ICD-10

C92.0

General information

Acute myeloid leukemia (AML) is a malignant lesion of the myeloid blood lineage. Uncontrolled proliferation of leukemia cells in the bone marrow leads to the suppression of other blood sprouts. As a result, the number of normal cells in the peripheral blood decreases, anemia and thrombocytopenia occur. Acute myeloid leukemia is the most common acute leukemia in adults. The likelihood of developing the disease increases sharply after age 50. The average age of patients is 63 years. Men and women of young and middle age suffer equally often. In the older age group, there is a predominance of males. The prognosis depends on the type of acute myeloid leukemia, with five-year survival rates ranging from 15 to 70%. Treatment is carried out by specialists in the field of oncology and hematology.

Causes of acute myeloid leukemia

The direct cause of the development of AML is various chromosomal abnormalities. Risk factors contributing to the development of such disorders include unfavorable heredity, ionizing radiation, contact with certain toxic substances, taking a number of medications, smoking and blood diseases. The likelihood of acute myeloid leukemia increases with Bloom's syndrome (short stature, high voice, characteristic facial features and a variety of skin manifestations, including hypo- or hyperpigmentation, skin rash, ichthyosis, hypertrichosis) and Fanconi anemia (short stature, pigmentation defects, neurological disorders, abnormalities of the skeleton, heart, kidneys and genital organs).

Acute myeloid leukemia quite often develops in patients with Down syndrome. Hereditary predisposition can also be traced in the absence of genetic diseases. With AML in close relatives, the likelihood of developing the disease increases 5 times compared to the population average. The highest level of correlation is found in identical twins. If acute myeloid leukemia is diagnosed in one twin, the risk in the other is 25%. One of the most important factors provoking AML are blood diseases. Chronic myeloid leukemia in 80% of cases transforms into an acute form of the disease. In addition, AML is often the outcome of myelodysplastic syndrome.

Ionizing radiation causes acute myeloid leukemia when the dose exceeds 1 Gy. The incidence increases in proportion to the radiation dose. In practice, staying in areas of atomic explosions and accidents at nuclear power plants, working with radiation sources without appropriate protective equipment, and radiotherapy used in the treatment of certain cancers are important. The cause of the development of acute myeloid leukemia upon contact with toxic substances is bone marrow aplasia as a result of mutations and damage to stem cells. The negative effects of toluene and benzene have been proven. Typically, AML and other acute leukemias are diagnosed 1-5 years after exposure to the mutagen.

Among the drugs that can provoke acute myeloid leukemia, experts name some drugs for chemotherapy, including DNA topoisomerase II inhibitors (teniposide, etoposide, doxorubicin and other anthracyclines) and alkylating agents (thiophosphamide, embiquin, cyclophosphamide, chlorambucil, carmustine, busulfan). AML can also occur after taking chloramphenicol, phenylbutazone and arsenic drugs. The share of drug-induced acute myeloid leukemia is 10-20% of the total number of cases of the disease. Smoking not only increases the likelihood of developing AML, but also worsens the prognosis. The average five-year survival rate and duration of complete remissions are lower for smokers than for non-smokers.

Classification of acute myeloid leukemia

The WHO classification of acute myeloid leukemia is very complex and includes several dozen types of the disease, divided into the following groups:

• AML with typical genetic changes.
• AML with changes due to dysplasia.
• Secondary acute myeloid leukemia resulting from treatment of other diseases.
• Diseases with myeloid lineage proliferation in Down syndrome.
• Myeloid sarcoma.
• Blastic plasmacytoid dendritic cell tumor.
• Other types of acute myeloid leukemia.

Treatment tactics, prognosis and duration of remissions for different types of AML can vary significantly.

Symptoms of acute myeloid leukemia

The clinical picture includes toxic, hemorrhagic, anemic syndromes and the syndrome of infectious complications. In the early stages, the manifestations of acute myeloid leukemia are nonspecific. There is an increase in temperature without signs of catarrhal inflammation, weakness, fatigue, loss of weight and appetite. With anemia, dizziness, fainting and pallor of the skin occur. With thrombocytopenia, increased bleeding and petechial hemorrhages are observed. Possible formation of hematomas with minor bruises. With leukopenia, infectious complications arise: frequent suppuration of wounds and scratches, persistent repeated inflammation of the nasopharynx, etc.

Induction programs can achieve remission in 50-70% of patients with acute myeloid leukemia. However, without further consolidation, most patients relapse, so the second stage of treatment is considered an obligatory part of therapy. The consolidation treatment plan for acute myeloid leukemia is drawn up individually and includes 3-5 courses of chemotherapy. In case of a high risk of relapse and already developed relapses, bone marrow transplantation is indicated. Other treatments for recurrent AML are still in clinical trials.

Prognosis of acute myeloid leukemia

The prognosis is determined by the type of acute myeloid leukemia, the age of the patient, and the presence or absence of a history of myelodysplastic syndrome. The average five-year survival rate for various forms of AML ranges from 15 to 70%, the probability of relapses ranges from 33 to 78%. Elderly people have a worse prognosis than younger people, which is explained by the presence of concomitant somatic diseases, which are a contraindication for intensive chemotherapy. With myelodysplastic syndrome, the prognosis is worse than with primary acute myeloid leukemia and AML that arose during pharmacotherapy for other oncological diseases.

24.10.2018

Acute myeloblastic leukemia is a malignant disease of the hematopoietic system, characterized by the difficulty of recognition and uncontrolled growth of cells of hematopoietic nature.

This disease is localized in the peripheral blood and bone marrow. With the development of acute myeloblastic leukemia, healthy cells are suppressed by malignant ones, infecting all organs of the body.

Reasons for development

Acute myeloblastic leukemia can be classified as a polyetiological pathology, the exact nature of which has not been established. There are some factors that may increase the risk of developing the disease:

• Chemical carcinogenesis. It has a harmful effect on the bone marrow cells of toxic chemical compounds of the herbicide and pesticide series.
• Ionizing radiation. Underlies the formation of malignant cells under the influence of radiation. A high increase in incidence was recorded in areas that were exposed to atomic bombs and explosions. Quite common in children.
• Biological carcinogenesis. It is a tumor transformation of myeloid lineage cells under the influence of various groups of oncogenic viruses.

Regardless of the causes of leukemia, the result of the destructive action is the same - damage to the DNA of blood cells, with the switching off of the gene responsible for the natural death of the cell. She becomes immortal, but acquires a distorted structure that is unable to function.

Factors in the formation of acute myeloid leukemia have been identified: exposure to chemicals, radiation and genetic factors.

There is a high probability of developing pathology during the first three to five years after chemotherapy. Alkalating substances, as well as anthracyclines and epipodophyllotoxins, pose a danger. In this case, leukemia is explained by specific metamorphoses in the chromosomes of malignant cells.

The connection between AML and benzene and other aromatic solvents is controversial. According to observations, the danger of working with these substances has been identified. But it is more of an additional factor than a main factor.

The causes of AML are associated with pre-leukemic dysfunctions (myelodysplastic syndrome, myeloproliferative syndrome). The percentage probability of developing acute myeloblastic leukemia depends on the form of pre-leukemia.

The effects of ionizing radiation have been proven by the results of the bombings of Hiroshima and Nagasaki. There has also been evidence of increased morbidity among radiologists who received high doses of radiation without appropriate protective measures.

Cases have been recorded in which AML was found in several family members, which indicates a high role of heredity in the pathologies of acute myeloid leukemia. If a person has AML, then the likelihood of the disease in his immediate family is three times higher than in ordinary people.

Some congenital conditions, such as Down syndrome, can increase the risk. With this condition, the likelihood of AML is increased by 10-20 times.

Symptoms of leukemia

In acute myeloblastic leukemia, anemic, hemorrhagic and toxic syndromes develop. They manifest themselves in the form of weakness, pallor, increased fatigue, loss of appetite and fever.

In patients, the lymph nodes are not enlarged and painless. In some cases, they can increase up to two centimeters, forming conglomerates of the cervical-supraclavicular zone.

On the part of the osteoarticular systems, a sign of myeloblastic leukemia may be severe pain in the legs and in the spinal column. As a result, movement and gait are impaired. The X-ray shows destructive changes.

With extramedullary tumor lesions, proptosis and gingivitis may occur. In some cases, AML is expressed by tumor infiltration of soft tissues, damage to the nasopharynx, and hypertrophy of the palatine tonsils.

The general symptoms of acute myeloblastic leukemia are:

• general weakness, fatigue, malaise;
• profuse sweating for no apparent reason;
• pallor of the skin and mucous membranes;
• swelling of the limbs and puffiness of the neck and face;
• persistent constant hyperthermia (increase in temperature) from 37.˚C to 39˚C and above;
• enlarged lymph nodes in all groups at the same time or in certain areas;
• muscle, bone, joint pain;
• shortness of breath and tachycardia (rapid heartbeat);
• nausea, vomiting and diarrhea;
• heaviness in the right hypochondrium and enlarged liver;
• enlarged spleen (splenomegaly);
• increased bleeding and fragility of blood vessels;
• decreased immune defense, manifested by the occurrence of severe respiratory infections, pneumonia and fungal infections of the mucous membranes;
• headaches and neurological disorders.

The rich clinical picture is due to the fact that all organs receive blood oversaturated with cancerous leukocyte cells. The process of their infiltration into healthy tissues with a blood supply begins. According to the World Health Organization, signs do not develop simultaneously, but are gradually added and joined to each other as the disease develops.

Diagnostics

To diagnose acute myeloblastic leukemia or the primary determination of leukemia, it is necessary to carry out certain measures that are clearly regulated. This scope of diagnostic measures consists of:

• General clinical blood test. This is the first step of early diagnosis. Timely implementation of this method increases the chances of successful treatment. Microscopy reveals an increased level of immature forms of leukocytes against the background of a general decrease in platelets and red blood cells. This condition is called blast crisis and leukemic failure, when the forms of mature and transitional leukocytes are absent.
• Bone marrow punctures and myelograms. They are the gold standard for diagnosis and the only method for reliably confirming a diagnosis of acute myeloid leukemia. They are used in the form of a sterile puncture (taking a bone marrow sample from the sternum) or a similar study from the wing of the ilium.
• Biochemical blood test. This study does not provide information about the nature of the disease, but only indicates the level of functional impairment of internal organs.
• ECG, general urinalysis, pulse oximetry, chest X-ray, abdominal ultrasound - studies are available and prescribed as needed.

Treatment and prognosis

A set of treatment procedures is carried out exclusively in medical institutions. Treatment of acute myeloid leukemia is strictly regulated by specialized protocols. It consists of two periods: pathogenetic therapy and basic anti-relapse measures.

• Use of induction therapy. This is the first stage of treatment, aimed at destroying malignant clones of blast cells with further restoration of hematopoiesis. With this method, several courses of chemotherapy with cytostatics are used.
• Anti-relapse treatment. The method consists of three blocks that can restore normal hematopoiesis and provide a favorable prognosis. It consists of chemotherapy, hormone therapy with glucocorticoids, and red bone marrow cell transplantation.
• Bone marrow stem cell transplant. The procedure is carried out by allogene, thanks to the implantation of foreign normal cells that cause a reaction against leukemoid cells that have undergone a special chemical treatment. Autogenous transplantation is carried out in stable remission with a maximum reduction in the malignant process. Implantation of cells occurs, giving rise to healthy hematopoiesis, eliminating acute myeloid leukemia.

Survival

For acute myeloid leukemia, the overall survival prognosis is 20-40%, and for children who have undergone transplantation - 40-50%. Children have a better prognosis than adults, with survival rates over the next five years ranging from 70 to 75%.

An unfavorable prognosis for life is a survival rate of 15% and a relapse rate of about 80% for acute myeloid leukemia with mutations in chromosomes 3.5 and 7.

Myeloblastic leukemia - a malignant blood disease characterized by the uncontrolled growth of immature blood cells (myeloblasts). Accumulating in the bone marrow, peripheral blood and internal organs, they cause severe dysfunction of all body systems.

Laboratory indicators

General blood test

• E red blood cells: reduced
• Reticulocytes: reduced
• Leukocytes: varies significantly from 0.1 10 9 /l to 100.0 10 9 /l,
  1. in 38% of patients leukocytes are normal or reduced
  2. in 44% increased to 15-20 10 9 /l
  3. 18% exceed 50.0 10 9 /l

• Platelets are reduced, less than 130.0 10 9 /l

• There are no eosinophils in the peripheral blood

• There are no basophils in the peripheral blood
• ESR increased, over 15 mm/hour
• Myeloblasts in the blood are defined as immature cells (more than 20%)

Bone marrow analysis

• The content of immature cells (myeloblastic cells) is more than 20%.
• The number of other bone marrow growth cells is reduced

Other studies:
Cytochemical reactions to determine the type of leukemia.

• Myeloid leukemia is characterized by positive reactions to lipids and to a specific enzyme (peroxidase). The reaction to glycogen is negative.

Immunological reactions (IR).
IR helps to most accurately determine the type of leukemia. Specific markers (antibodies) are used to structures on blood cells (antigens) characteristic of a particular type of leukemia.

Symptoms

1. Symptoms of intoxication:

• Temperature 38 - 40 °C
• Headache
• Excessive sweating
• Muscle pain

1. Symptoms of increased bleeding due to decreased platelets:

• Pinpoint subcutaneous hemorrhages
• Easily bruise
• Bleeding gums
• Nosebleeds, gastrointestinal, uterine

1. Symptoms caused by decreased red blood cells (anemia)

• Pale skin
• General weakness
• Lack of air during physical activity
• Dizziness
• Rapid heartbeat

1. Symptoms associated with excessive proliferation of myeloblastic cells:

• Enlarged lymph nodes (rare)
• Enlarged liver and spleen (not in all cases)
• Joint pain (rare)
• Red-blue spots on the skin (leukemids) - rare
• Nervous system lesions (rare)
• Rapid depletion of vital organs (heart, kidneys, lungs)

1. Symptoms of infectious complications due to a decrease in the number of leukocytes:

• Bacterial and fungal infections (necrotizing stomatitis, tonsillitis, bronchitis, pneumonia, paraproctitis, etc.).

Cause of myeloblastic leukemia

Under the influence of ionizing radiation, viruses or chemicals, a mutation of the mother blood cell occurs. Its uncontrolled division leads to the spread of tumor cells throughout the body.

How to treat?

Main directions:

• Chemotherapy
• Transfusion of blood components
• Antibiotic therapy
• Bone marrow transplant

Chemotherapy is performed according to special programs:

1. Remission activation stage.

• Scheme “7+3”, Cytosar 100 mg/m², 2 times a day, 7 days; Rubomycin 45/m², 1 time per day , 3 days.
• Scheme “5+2”, Cytosar - 5 days, Rubomycin - 2 days. (Scheme for persons over 60 years of age)

The scheme is repeated 2-3 times until incomplete remission is achieved (disappearance of symptoms caused by excessive proliferation of blast cells, normalization of blood and bone marrow analysis, myeloblast cells in the bone marrow analysis no more than 20%).

1. Stage of strengthening remission.

• The “7+3” or “5+2” schemes are prescribed, 2-3 courses each.

1. Prevention of complications from the nervous system (neuroleukemia).

Carried out at the stage of activation of remission, drugs (Dexamethasone, Methotrexate, Cytosar) are administered under the membranes of the spinal cord (intrathecal).

1. Remission maintenance stage

Monthly Cytosar 5 days 100 mg 2 times a day, together with Thioganin 10 mg/m², every 12 hours. Repeat this scheme for 5 years.
Transfusion of blood components:

• Cryoplasma
• Platelet concentrate
• Red blood cell mass

Goal: to restore the deficiency of blood cells (erythrocytes, platelets, etc.).
Antibiotic therapy
Goal: to prevent infectious complications associated with taking chemotherapy drugs that reduce the number of immune cells (leukocytes). Treatment options:

• Tsiprinol 1 g/day in combination with Diflucan 400 mg daily
• Biseptol 6 tablets a day in combination with nystatin 4-6 million units/day

An alternative treatment option for myeloid leukemia is a bone marrow transplant (usually from a sibling).