Acute Myeloid Leukemia - The Leukemia & Lymphoma Society

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Low Blood Cell Counts. AML decreases the production of normal blood cells.In addition, chemotherapy is toxic to both normal blood cells and AML cells. Thenormal blood cells are eliminated from the marrow along with AML cells. For thepatient, this results in a severe deficiency in the◦{Red cells (anemia)◦{Platelets (thrombocytopenia)◦{White cells called “neutrophils” and “monocytes” (neutropenia and monocytopenia).Transfusion of red cells and platelets is almost always needed for a period ofseveral weeks during treatment. After that, the blood cell counts usually returntoward normal.Infection. During treatment for AML, the deficiency of neutrophils andmonocytes (types of white cells) can lead to infection from bacteria and funginormally present in the environment, on the skin and in the nose, mouth or colon.The risk of infection may be increased because chemotherapy damages the liningof the mouth and intestines, making it easier for bacteria to enter the blood. Whenthe white cell count is low and infection risk is increased, antibiotics are given toprevent or treat infection. Transfusion is not generally used for patients with a lowneutrophil count, but can be used in patients with high fever, infection that isunresponsive to antibiotics, blood fungal infections or septic shock.Growth factors may be given to the patient to stimulate the marrow to make newwhite cells. The growth factors used most frequently are G-CSF (granulocytecolony-stimulating factor; filgrastim [Neupogen®] and pegfilgrastim [Neulasta®])and GM-CSF (granulocyte-macrophage colony-stimulating factor; sargramostim[Leukine®]). These agents are used in children only in special circumstances.Because the patient has an increased risk of developing an infection, the medicalstaff and family and friends need to practice frequent and vigorous hand washingand take other precautions to avoid exposing patients to bacteria, viruses and otherinfection-causing agents. Caregivers for patients with central lines or ports need tobe meticulous in the cleaning of catheters.Patients at home should not delay in seeking medical attention if any signs ofinfection develop. A rise in temperature to 101°F or higher, or the onset of chills,may be the only sign of infection in a patient with a very low white cell count.Other signs of infection may include persistent coughing; tenderness at a site proneto infection, such as the area surrounding the anus or the facial sinuses; sore throat;pain on urination; or frequent loose stools.page 24 I 800.955.4572 I www.LLS.org
Other Side Effects. Chemotherapy affects tissues that normally have a high rateof cell turnover. Thus, the lining of the mouth, the lining of the intestines, the skinand the hair follicles may be affected. Common side effects may include◦{Mouth ulcers◦{Diarrhea◦{Temporary hair loss◦{Rashes◦{Nausea and vomiting◦{Fatigue.Some AML patients may build up uric acid in their blood as a result of a very highwhite cell count. The use of chemotherapy may also increase uric acid, which is achemical in the cell. Uric acid enters the blood and is excreted in the urine. If manycells are killed simultaneously by therapy, the amount of uric acid in the urine canbe so high that kidney stones can form. This may seriously interfere with the flowof urine. Drugs such as allopurinol (Zyloprim®) or rasburicase (Elitek®) can be givento minimize the buildup of uric acid in the blood.There are drugs and other supportive therapies to prevent or manage many sideeffects. For more information see the free LLS publications Blood Transfusion,Cancer-Related Fatigue Facts and Understanding Drug Therapy and ManagingSide Effects.Sometimes, a drug or a drug combination causes effects that continue for a periodof time after treatment ends. Some effects may be long-lasting (see Long-TermEffects of Treatment on page 26).Talk to yourdoctor aboutPossible side effects and follow-up care.Follow-up Care. Some of the tests that were done to diagnose AML may berepeated to◦{Follow the effects of treatment◦{Make decisions about whether to continue, intensify, change or stop treatment.After treatment, patients who are in remission and have completed postremissiontherapy continue to be examined regularly by their doctors. Careful periodicAcute Myeloid Leukemia I page 25
Page 2: A Message From John WalterPresident
Page 5 and 6: LLS Has Ways to Help. Treatment for
Page 7 and 8: Depression. Treatment for depressio
Page 9 and 10: AML may develop from the progressio
Page 11 and 12: DiagnosisAn accurate diagnosis of t
Page 13 and 14: Other Tests. “Karyotyping” and
Page 15 and 16: Table 2. Some AML Risk FactorsCerta
Page 17 and 18: Talk to yourdoctor aboutYour treatm
Page 19 and 20: Postremission Therapy. Normal blood
Page 21 and 22: ill to have an allogeneic stem cell
Page 23 and 24: All-trans retinoic acid (ATRA), a v
Page 25: Children who have AML are treated w
Page 29 and 30: Treatment Outcomes. Patients with A
Page 31 and 32: Research and Clinical TrialsThe pro
Page 33 and 34: Normal Blood and MarrowBlood is com
Page 35 and 36: Medical TermsAbsolute Neutrophil Co
Page 37 and 38: abnormalities in cancer cells. No s
Page 40 and 41: Colony-Stimulating Factor. See Grow
Page 42 and 43: Extramedullary Myeloblastoma. See C
Page 44 and 45: Hematologist. A medical doctor who
Page 46 and 47: Inversion. An abnormality of chromo
Page 48 and 49: somatic mutations, leading to the f
Page 50 and 51: of one blood cancer cell among 500,
Page 52 and 53: Stem Cells. Primitive cells in marr
Page 54 and 55: Howlader N, Noone AM, Krapcho M, Ne
Page 56: For more information, please contac

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