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Acute Myeloid Leukemia Diagnosis and Treatment - A Detailed Guide

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Multiple advanced approaches are available for acute myeloid leukemia diagnosis and treatment. Usually, a combinatorial approach is implemented for the effective management of the condition. Acute myeloid leukemia treatment interventions are prescribed based on the type of AML, the patient’s age, and overall health.

Procedures or Tests for Acute Myeloid Leukemia Diagnosis

The following are the important procedures recommended for an accurate acute myeloid leukemia diagnosis:

Blood Tests

Although blood tests may not be enough for the definitive diagnosis of acute myeloid leukemia (AML), they may provide detailed information about the overall health of the patients. Various types of AML diagnosis blood tests are conducted on an individual suspected of AML.

A complete blood count (CBC) determines the number of different types of blood cells, i.e., red blood cells, white blood cells, and platelets. In patients with AML, there is an increase in the number of abnormal cells.

Clinicians may also advise the patient to undergo peripheral blood smear tests. The test involves the examination of blood cells under the microscope.

The doctor may also recommend the patient undergo kidney function tests and liver function tests to determine the health status of these organs. The patients may also undergo chemical analysis of the blood to check the levels of electrolytes.

Sometimes, in AML patients, the blood clotting ability may be affected. Thus, the patient may also be advised to undergo tests to determine activated partial thromboplastin time and prothrombin time.

Bone marrow aspiration and biopsy

Bone marrow aspiration and biopsy are the important tests conducted in patients suspected of having AML. These tests are performed for a definitive acute myeloid leukemia diagnosis. Bone marrow aspiration and biopsy provide detailed information about the bone marrow cells and help confirm leukemia and its subtypes. Both aspiration and biopsy involve obtaining bone marrow samples. In aspiration, the clinicians obtain the liquid bone marrow sample through a thin, hollow needle. A relatively larger needle is used to withdraw solid tissue from the bone marrow during a biopsy. These samples are further examined under a microscope for the presence of cancer cells.

Biomarker testing of the leukemia cells

The biomarker test is an important test for acute myeloid leukemia diagnosis. These tests help in the identification of the molecular and genetic characteristics of the leukemia cells. Biomarker tests help in risk stratification to determine the AML leukemia prognosis. These tests also help develop optimal treatment strategies, as certain mutations may influence the treatment choice. The tests are also helpful in monitoring minimal residual disease (MRD) to evaluate treatment efficacy.

Immunohistochemistry

Immunohistochemistry is the technique that determines the presence of specific proteins in the tissue under analysis by using antibodies to bind to target proteins. Although immunohistochemistry is generally used for solid tumors, it is sometimes used in certain cases for diagnosing and characterizing AML, especially while evaluating biopsy samples. Immunohistochemistry helps identify different types of cells present in the bone marrow. It also provides vital information about the type of AML and the presence of abnormal antigen expression. This information assists in characterizing the disease and has prognostic implications.

Flow cytometry

This technique involves the analysis of the chemical and physical characteristics of leukemia cells in a fluid by passing it under a laser beam. Through this technique, the specialists assess the immunophenotype of malignant cells and identify specific markers on the cell surface. Flow cytometry also determines blast percentage (blast cells in bone marrow), identifies aberrant antigen expression, and monitors minimal residual disease (to analyze treatment efficacy).

Karyotyping or cytogenetics

Cytogenetics is the technique used to detect changes in the chromosomes in leukemia cells. The technique looks for broken, rearranged, missing, or extra chromosomes. Cytogenetic testing in acute myeloid leukemia diagnosis examines the structure of the chromosomes along with their numbers. There is an association between specific chromosomal abnormalities and different AML subtypes. For instance, inv (16), t (8;21), or t (15;17) translocations are associated with different AML subtypes.

Molecular testing

Molecular testing is a method for acute myeloid leukemia diagnosis that provides information about genetic mutations in leukemia cells. Molecular testing helps determine the acute myeloid leukemia survival rate, optimizes treatment strategies, and identifies targeted therapies in certain cases of AML. The AML mutations detected by molecular testing include CEBPA mutations, FLT3 mutations, IDH1 and IDH2 mutations, TP53 mutations, and NPM1 mutations.


Imaging tests

As AML involves the bone marrow and blood, imaging tests are not often used for acute myeloid leukemia diagnosis. However, the doctor may recommend imaging tests to assess the AML complications or to determine the involvement of various organs that may affect the treatment decisions. The type of imaging tests and their requirements depend on the symptoms and overall health status of the patient.

Computed tomography (CT or CAT) scan

Computed tomography uses X-rays to obtain detailed images of the target organ. In patients diagnosed with AML through biopsy and bone marrow aspiration, a CT scan allows clinicians to determine the infiltration of leukemia cells into various organs, such as the spleen, liver, and lymph nodes. A CT scan also assists in evaluating the efficacy of the treatment by comparing the images after the treatment with baseline images.

Magnetic resonance imaging (MRI)

MRI is the technique to obtain clear images with powerful magnetic fields and radio waves. It helps to detect the involvement of the brain and spinal cord in AML. MRI also assists in determining the swollen lymph nodes in the abdomen or chest due to AML. MRI improves the efficiency of acute myeloid leukemia diagnosis.

Positron emission tomography (PET) or PET-CT scan

A PET scan uses radioactive sugar analogs to determine the spread of cancer to various organs. The technique helps determine the extent of the spread of AML and assists in appropriately staging the disease. It also monitors the patient’s response to the treatment given. It also assesses the minimal residual disease that may predict AML relapse.

Lumbar puncture

Lumbar puncture (spinal tap) involves obtaining the cerebrospinal fluid from the spinal canal with the help of a thin needle for therapeutic and diagnostic purposes. It assists clinicians in determining the involvement of the CNS in patients with acute myeloid leukemia.

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What is the Effective Acute Myeloid Leukemia Treatment?

The following are some of the most effective acute myeloid leukemia treatment options:

Chemotherapy for Acute Myeloid Leukemia

Chemotherapy is one of the most common acute myeloid leukemia treatment modalities. Chemotherapy for acute myeloid leukemia aims to eliminate or reduce the number of leukemia cells in the blood and the bone marrow and achieve remission through cytotoxic or cytostatic drugs. Chemotherapy, in some cases, may also be used in combination with targeted therapy. Chemotherapy for acute myeloid leukemia treatment may be done through the following steps:

Remission-induction therapy

Remission induction therapy is a critical phase in AML treatment. This therapy aims to achieve remission by lowering the number of leukemia cells to the extent that they are not detectable under the microscope.

Consolidation therapy

Once the remission is achieved with remission induction therapy, the next step is consolidation therapy. It aims to remove the remaining leukemia cells to lower the risk of relapse and increase the remission period.

Maintenance therapy

Maintenance therapy aims to maintain remission and minimize the risk of relapse. In contrast to induction and consolidation therapy, not all patients with AML require maintenance therapy. The decision to initiate maintenance therapy depends upon the patient's age, overall health status, leukemia characteristics, and response to prior treatment.

Targeted therapy

Targeted therapy uses drugs that target certain pathways of molecules that are vital for the growth and proliferation of leukemia cells. Unlike traditional chemotherapy, which targets both healthy and malignant cells, targeted therapy only targets the molecules and pathways specifically in the malignant cells.

Allogeneic stem cell transplantation

Allogeneic stem cell transplantation is a potential AML cancer treatment option for certain patients. The procedure involves the transplantation of allogeneic stem cells from a healthy donor. The procedure is performed in patients with certain genetic mutations, high-risk diseases, and relapses after initial treatment.

Radiation therapy

Radiation therapy is not a standard acute myeloid leukemia therapy and is used in certain specific situations. Oncologists recommend this therapy when patients have solid organ involvement or involvement of the central nervous system. Radiation therapy is also used in conditioning before bone marrow transplantation.

Why Choose HCG for Acute Myeloid Leukemia Diagnosis and Treatment?

HCG is an advanced center for acute myeloid leukemia diagnosis and treatment. The center has a strong reputation for managing all types of hematological malignancies. Further, the multidisciplinary team at the center comprises oncologists, hematologists, radiation specialists, and pathologists to facilitate excellent disease management in AML patients. The center also has advanced surgical facilities to perform bone marrow transplantation.

Conclusion

Various AML diagnostic methods include blood tests, bone marrow aspiration and biopsy, biomarker tests, molecular tests, imaging tests, and lumbar punctures. Effective acute myeloid leukemia treatment options include chemotherapy, targeted therapy, stem cell transplantation, and radiation therapy.

Frequently Asked Questions

At what age is acute myeloid leukemia diagnosed?

Acute myeloid leukemia may occur at any age. However, it is more common in people >45 years of age.

The average white blood count in patients with acute myeloid leukemia is 100,000–400,000/μl.

Induction therapy usually takes about one month, while the average length of consolidation therapy is around six months.

A bone marrow transplant is one of the most effective methods for acute myeloid leukemia treatment. Further, certain novel drugs are also effective in acute myeloid cancer treatments.

Cytogenetic testing for leukemia requires about 2 to 3 weeks.

The total AML therapy session takes around 6 to 7 months for most patients. However, the duration of chemotherapy is higher in patients requiring maintenance therapy.