Acute leukemia or acute myeloid leukemia (acute myeloid leukemia, AML, OneLL) - malignant disease arising from malignant transforming and disturbance of differentiation of hematopoietic cells at the level of myeloid progenitor cells. Acute myeloid leukemia or, more precisely, acute leukemia nelimfoblastnaya often clinically characterized by fever, bleeding, enlarged liver and spleen, anemia. Less frequently observed lymphadenopathy, articular syndrome, central nervous system.
Cytogenetic damage in acute myeloid leukemia detected in 80% of cases. Some of them may be suspected on the clinical picture. Some of the damage attributed to the favorable characteristics of the disease, which increases the chances of remission. For example, a chromosomal translocation t (8; 21), inversion of the 16 pairs of chromosomes inv [16], the translocation t (15; 17), and in the latter case, remission can be quite lengthy. In general, these patients have a 90% yield in remission. In secondary AML found deletions 5 and 7. Nepkotorye researchers believe that they arise from the treatment of primary myeloid leukemia.
The classification of acute myeloid leukemia according to FAB classification is as follows: M0 - with minimal differentiation M1 - without ripening M2 - a maturing M3 - acute promyelocytic leukemia M4 - acute myelomonocytic leukemia M5 - acute monocytic leukemia M6 - acute erythroleukemia M7 - acute megakaryoblastic leukemia
Laboratory diagnosis is based primarily on a study of red bone marrow. The diagnosis of acute myeloid leukemia is established when there is more than 30% of nonlymphoid blast cells. In this prognostically favorable sign is the detection of Auer rods in M1, leukocytosis with less than 20,000 M2, the presence of more than 3% of atypical eosinophils in the M4. Groups M5 and M7 are at high risk. Additional cytochemical and cytogenetic studies can clarify the form of the disease according to the classification and choose the treatment strategy.
Therapeutic strategy for acute myeloid leukemia is similar to the treatment of lymphoid, but is often associated with the development of complications. First, you need to achieve induction of remission, and then neuroleukemia prevention, supportive care. Should be actively engaged in prevention and treatment of complications, which often include hemorrhage and infection. Differences are not only more attention to the complications, but other than lymphoid leukemias combinations of chemotherapeutic drugs. As a reference drug in all phases of treatment of AML is usually used cytarabine. Used as vincristine, rubomitsin, vepezid, doxorubicin, cyclophosphamide, 6-thioguanine, mitoxantrone. In acute promyelocytic leukemia detection (M3), it becomes possible to transfer the disease into complete remission through the use of all-trans retinoic acid promotes the differentiation of promyelocytes. This type of myeloid leukemia occurs in about 10% of all cases of AML. Effectiveness of treatment depends on the use of an optimum combination of the drug with chemotherapy.
Conducting intensive chemotherapy yields complete remission in approximately 80-85% of individuals. The peculiarity of the disease characterized by relapses of the disease in half of them for 5 years. In patients at high risk are usually shown holding a bone marrow transplant.
Except for the treatment of different variants of M3 acute myeloid leukemia is similar.
