From the Research
Introduction to Acute Myeloid Leukemia (AML)
Acute Myeloid Leukemia (AML) is a malignancy of the stem cell precursors of the myeloid lineage, affecting the production of red blood cells, platelets, and white blood cells other than B and T cells 1. This disorder is characterized by a clonal proliferation derived from primitive haematopoietic stem cells or progenitor cells, leading to abnormal differentiation of myeloid cells and a high level of immature malignant cells 2.
White Blood Cell Count and Neutrophil Count in AML
In AML, the white blood cell count is often elevated due to the increased number of immature malignant cells, also known as blasts, in the blood 2. However, the neutrophil count, which is a type of white blood cell, is often decreased. This decrease in neutrophil count is due to the abnormal differentiation of myeloid cells, resulting in fewer mature neutrophils being produced 2.
Pathophysiology of AML
The pathophysiology of AML involves genetic variations that lead to neoplastic changes and clonal proliferation 1. The genomic landscape of AML has been determined, and genetic instability is infrequent, with a relatively small number of driver mutations 2. Mutations in genes involved in epigenetic regulation are common and are early events in leukaemogenesis 2.
Diagnostic Markers for AML
Abnormalities in neutrophil peroxidase activity have been detected in some cases of AML, which may serve as useful leukaemic markers 3. Additionally, neutrophil scattering parameters, such as neutrophil side scatter mean intensity and neutrophil forward scatter mean intensity, have been shown to be highly efficient in differentiating AML from acute lymphoid leukemia (ALL) and control groups 4.
Treatment of AML
The treatment of AML typically involves intensive chemotherapy, leukapheresis, or hydroxyurea to reduce the white blood cell count and prevent complications such as leukostasis and tumor lysis syndrome 5. Supportive treatment with uric acid lowering agents, such as allopurinol and rasburicase, and aggressive intravenous fluid hydration may also be necessary to manage these complications. In some cases, allogeneic haematopoietic stem cell transplantation may be used to consolidate remission in patients who are deemed to be at high risk of relapse 2.
Caveats and Differentials
It is essential to note that the diagnosis and treatment of AML can be complex and require careful consideration of various factors, including the patient's age, overall health, and specific genetic mutations 1, 2. A thorough differential diagnosis should be performed to rule out other conditions that may present with similar symptoms, such as acute lymphoid leukemia or other myeloproliferative disorders.
Treatment Dosages and Durations
The dosages and durations of treatment for AML may vary depending on the specific protocol and the patient's response to therapy. For example, hydroxyurea may be administered at a dose of 1-3 grams per day to reduce the white blood cell count, while allopurinol may be administered at a dose of 300-600 mg per day to prevent tumor lysis syndrome 5. The duration of treatment may range from several weeks to several months, depending on the patient's response to therapy and the specific treatment protocol.