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What is the cause and treatment for acute myeloid leukaemia?

Answered by: Dr Shirish Kumar | Haematologist,
WHO,
Geneva

Q: I lost my 18-year-old son suffering from acute myeloid leukaemia (AML). What are the reasons for getting AML? How can it be prevented and what is the treatment for it?

A:I am very sorry to learn of your bereavement and can well imagine your state of mind. Unfortunately, acute myeloid leukaemia as a disease, even with current standard chemotherapy regimens, has a 5-year survival rate of only about 25-30%, which is considered a cure. The prognosis is governed by several factors including age of the patient, a prior history of an antecedent haematologic disease (usually a myelodysplastic syndrome), cytogenetic abnormalities and mutations. In this disease, the precursor cells of blood (blasts) get arrested at an early stage of development likely due to activation of abnormal genes caused by changes in the chromosomes, which carry these genes. This leads to diminished production of normal blood cells–red blood cells (leading to anaemia), white blood cells (predisposing to infections) and platelets (causing bleeding) and accumulation of abnormal cells in different body organs impairing their function. It is still not known what leads to this disease as most patients have no identifiable risk factors. Among the factors implicated are:

Prior haematologic disease like a myelodysplastic syndrome, aplastic anemia, myelofibrosis, paroxysmal nocturnal haemoglobinuria, etc.

Some congenital diseases like Down’s syndrome, Bloom’s syndrome, Fanconi’s anaemia etc.

Genetic disorders of enzymes that metabolise carcinogens

Exposure to environmental carcinogens like radiation, benzene or chemotherapeutic agents for treatment of another malignancy. The current treatment protocols usually include a phase of induction followed by a phase of consolidation along with autologous or allogeneic stem cell transplantation. These standard chemotherapy regimens cure only a minority of patients and there is constant endeavour to find newer cures. As the cause of the disease is still not known, there is no way to prevent it. The treatment being offered in most hospitals is standardised as best as possible but results continue to be disappointing. I hope this helps you cope with your loss as nothing more could have been offered as of date.