Definition of Acute myelogenous leukemia

Acute myelogenous leukemia: Abbreviated AML. Also called acute myeloid leukemia or acute nonlymphocytic leukemia (ANLL). A quickly progressive malignant disease in which there are too many immature blood-forming cells in the blood and bone marrow, the cells being specifically those destined to give rise to the granulocytes or monocytes, both types of white blood cells that fight infections. In AML, these blasts do not mature and so become too numerous. AML can occur in adults or children.

The early signs of AML may be similar to the flu or other common diseases with fever, weakness and fatigue, loss of weight and appetite, and aches and pains in the bones or joints. Other signs of AML may include tiny red spots in the skin, easy bruising and bleeding, frequent minor infections, and poor healing of minor cuts.

First, blood tests are done to count the number of each of the different kinds of blood cells and see whether they are within normal ranges. In AML, the red blood cell levels may be low, causing anemia; platelet levels may be low, causing bleeding and bruising; and the white blood cell levels may be low, leading to infections.

A bone marrow biopsy or a bone marrow aspiration may be done if the results of the blood tests are abnormal. During a bone marrow biopsy, a hollow needle is inserted into the hip bone to remove a small amount of the marrow and bone for examination under a microscope. In a bone marrow aspirate, a small sample of liquid bone marrow is withdrawn through a syringe.

A lumbar puncture, or spinal tap, may be done to see if the disease has spread into the cerebrospinal fluid, which surrounds the central nervous system (CNS) -- the brain and spinal cord.

Other key diagnostic tests may include flow cytometry (in which cells are passed through a laser beam for analysis), immunohistochemistry (using antibodies to distinguish between types of cancer cells), cytogenetics (to determine chromosome changes in cells), and molecular genetic studies (DNA and RNA tests of the cancer cells).

The primary treatment of AML is chemotherapy. Radiation therapy is less common; it may be used in certain cases. Bone marrow transplantation is under study in clinical trials and is coming into increasing use.

There are two phases of treatment for AML. The first phase is called induction therapy. The purpose of induction therapy is to kill as many of the leukemia cells as possible and induce a remission, a state in which there is no visible evidence of disease and blood counts are normal. Patients may receive a combination of drugs during this phase including daunorubicin, idarubicin, or mitoxantrone plus cytarabine and thioguanine. Once in remission with no signs of leukemia, patients enter a second phase of treatment.

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