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Acute Myeloid Leukemias

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What is leukemia?

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Definition

Your blood contains cancer cells. These are immature blood cells called “blasts.”

Leukemia

The disease progresses rapidly, and treatment must begin within days of the diagnosis.

Acute

The “blasts” accumulate in your bone marrow, which can no longer properly produce normal blood cells.

Myeloid

Your blood contains cancer cells. These are immature blood cells called “blasts.”

Leukemia

The disease progresses rapidly, and treatment must begin within days of the diagnosis.

Acute

The “blasts” accumulate in your bone marrow, which can no longer properly produce normal blood cells.

Myeloid

Understanding Leukemias

The cause is most often unknown.
Acute myeloid leukemias are generally not hereditary, although rare families may have a predisposition, with several members affected.

The disease can occur at any age but mainly affects adults over 40.
More than 50% of patients are over 65 years old.

About 5 in 100,000 people are affected by AML.

The diagnosis is based on:

  • Blood tests (CBC): to identify possible abnormalities, such as low red blood cells, white blood cells, or platelets.

  • Bone marrow examination (myelogram): allows for cytology tests (looking for abnormal cells, particularly immature “blasts” and morphological abnormalities), cytogenetics (chromosome or karyotype analysis), molecular biology (detection of genetic mutations), and flow cytometry (analyzing cell characteristics, such as the presence of specific surface markers).

  • Bone marrow biopsy (hip bone puncture) may sometimes be required for cerebrospinal fluid collection (to check for possible neurological involvement).

  • Additional assessments may be performed before starting treatment: kidney, liver, lung (chest X-ray), and heart (electrocardiogram, echocardiography) evaluations. Geriatric assessment may be performed depending on age or comorbidities.

Substances: tobacco, chemicals, ionizing radiation, chemotherapy or radiotherapy used to treat other cancers

Genetic abnormalities (trisomy 21, neurofibromatosis, or Fanconi anemia)
or pre-existing blood disorders (myelodysplastic syndromes, etc).

  • Fatigue, paleness, palpitations, and shortness of breath: signs of anemia (low red blood cells). If you have coronary artery disease, you may also experience angina attacks.

  • Fever and infections (especially lung infections): signs of leukopenia or neutropenia (low white blood cells). These infections can become serious without antibiotic treatment.

  • Bleeding (especially from mucous membranes), red spots on the limbs, and bruises: signs of thrombocytopenia (low platelets). Bleeding can be worsened if you take anticoagulants or antiplatelet medications (aspirin, Plavix).

Treatment of Acute Myeloid Leukemia

The treatment aims to eliminate the “blasts,” allowing the normal bone marrow to rebuild healthy blood cell populations (red blood cells, white blood cells, and platelets).

Treatment is carried out in several phases.

If you are under 60 years old, or over 60 without comorbidities:

Hospitalization: 4–6 weeks (10 days of treatment + 3–4 weeks of monitoring to reduce the risk of infection)

1. Catheter Placement
The treatment can be harsh on the veins in the arms, so a catheter is placed in a large vein near the heart, usually in the neck (procedure performed in the operating room). You will keep it for the entire duration of treatment, including at home, with care provided by a visiting nurse.

2. Intensive Chemotherapy (“3+7” Regimen)

Cytarabine: administered as a continuous intravenous infusion for 7 days.

Daunorubicin and Idarubicin: administered intravenously for 3 days following cytarabine.

Specific inhibitors: in certain cases, depending on your type of leukemia, drugs such as Mitoxantrone or Ivosidenib may be added. Your doctor may also offer you the option to participate in a clinical trial to access an innovative treatment.

Goal: to destroy the diseased cells (blasts) present in your blood and bone marrow.

This treatment also lowers all blood cell counts (white blood cells, red blood cells, and platelets), making you more susceptible to infections. During this 3–4 week period, called aplasia, you will remain hospitalized to protect you from infections while your body begins producing enough blood cells again.

During this period:

  • Staff and visitors must wear masks to prevent transmitting germs to you.

  • Mouth rinses are prescribed to prevent fungal infections.

  • You may receive antibiotics and antifungal medications, as well as platelet or red blood cell transfusions if needed.

  • A protective diet is implemented to reduce risks associated with certain foods.

  • Other common side effects include hair loss, fever, nausea, fatigue, and vomiting—some of which can be managed with anti-nausea medications and digestive aids.

At the end of the induction phase, a follow-up bone marrow test (myelogram) is performed to check whether the bone marrow has resumed normal blood cell production and whether the leukemia cells have been eliminated. If successful, this is called complete remission, and you can proceed to the next phase!

A few weeks after induction treatment

During hospitalization, this phase includes several courses of chemotherapy, usually 2 to 4, spaced a few weeks apart. Between each course, a rest period is scheduled to allow your body—especially your bone marrow—to rebuild blood cells. You may return home between courses.

Goal: to strengthen the results of the initial treatment and reduce the risk of relapse. This phase aims to eliminate any residual leukemia cells, even if they are no longer visible in tests.

Performed after the induction and consolidation phases, if you are at high risk of relapse.

This is an allogeneic stem cell transplant, which requires a compatible donor (human leukocyte antigen, or HLA match). Most often, the donor is a family member (brother, sister, parent, or child), but it can also be anyone whose bone marrow is compatible with yours.

Goal: to replace diseased bone marrow with healthy bone marrow.

Learn more about “transplantation.”

AZA VEN:
This treatment aims to control the disease while preserving quality of life, without using intensive chemotherapy.

Adjusting the treatment cycles according to the disease’s progression provides a personalized approach that is generally better tolerated, especially in the most vulnerable patients. The treatment can start in the hospital and then continue in an outpatient setting or at home through home hospitalization services.

Learn more

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