Myeloid leukaemia (acute)
Acute myeloid leukaemia is a rare cancer of the white blood cells. Acute myeloid leukaemia is the most common leukaemia in adults, and although it can occur at any age, it is more commonly seen in older adults. Approximately 3000 new cases are diagnosed each year in the UK.
Article by Margaret Ann Perry
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Definition
Acute myeloid leukaemia is a rare cancer of the white blood cells. It is the most common leukaemia type in adults, and although it can occur at any age, it is more commonly seen in older adults with an average age for diagnosis of 67 years (Cleveland Clinic, 2023).
Since the early 1990s, acute myeloid leukaemia incidence rates have increased by more than a quarter (28%) in the UK, with a greater prevalence in men than women (Cancer Research UK, 2018). There are approximately 3000 new cases diagnosed in the UK each year (Cancer Research UK, 2018).
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Risk factors
The cause of most cases of acute myeloid leukaemia is unknown. However, there are several risk factors that increase the risk of developing acute myeloid leukaemia.
Smoking
Smoking is now linked to the development of several cancers and it is the only proven lifestyle related risk factor for acute myeloid leukaemia (American Cancer Society, 2018). The role of practice nurses in encouraging smoking cessation is therefore a vital component in reducing risk.
Benzene exposure
Benzene is used in various industries (oil refineries, chemical plants and the rubber industry). Exposure to dyes, herbicides and pesticides have also been implicated as potential risk factors for development of acute myeloid leukaemia (West et al, 2000).
Past chemotherapy
Previous treatment with certain chemotherapy drugs (such as chlorambucil, melphalan or cyclophosphamide) for Hodgkin's lymphoma or breast cancer increases risk (Seiter, 2023), but disease onset may be many years
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Aetiology
Although still not fully understood, it is thought that the development of bone marrow cells is arrested at an early stage in their growth, leading to a decrease in the numbers reaching maturity. The subsequent rapid proliferation of the abnormal myeloblasts, along with a reduction in their ability to undergo programmed cell death (apoptosis), results in their accumulation in the bone marrow, the blood, and, frequently, the spleen, liver and lymph nodes (Cancer Research UK, 2020; Seiter, 2023).
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Symptoms
Symptoms arise as a result of the abnormal blood cells produced by the bone marrow and their failure to function effectively. The bone marrow becomes filled with immature cells (myeloblasts) that severely impede the production of healthy cells. In healthy individuals, red blood cells deliver oxygen to cells around the body, while white blood cells help to fight infections, and platelets are involved in the clotting mechanism preventing abnormal bleeding. Once these functions are impaired several symptoms develop.
Practice nurses who run minor illness clinics may see patients complaining of:
- fever
- fatigue
- weight loss
- excessive bruising
- nose bleeds
- anaemia-related symptoms, such as shortness of breath or chest pain (Davis et al, 2014)
These symptoms are a red flag according to the National Institute for Health and Care Excellence (2023) guidelines for suspected cancer, so should alert the nurse to the need for urgent full blood count.
Another possible presentation in
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Diagnosis
Once the diagnosis is suspected, the patient is assessed in the hospital setting where a thorough history is taken alongside a clinical examination before further tests are initiated.
A full blood count will determine the presence of anaemia and will also give an indication of the white cell count. The number of neutrophils is usually depleted and blast cells are seen in their place (Tidy, 2016). A peripheral blood smear will also be examined and will assess changes both to the appearance and the number of cells and will help confirm the diagnosis. Other investigations will also be requested including:
- Chest X-ray to check for both lung and cardiac problems
- Assessment of myocardial function is needed prior to commencing treatment as many of the chemotherapeutic drugs are cardiotoxic (Seiter, 2023). For those with known coronary heart disease, echocardiography or multiple gated acquisition (MUGA) scanning is used. The latter is a
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Treatment
Treatment is planned with the input of the multidisciplinary team and will consider several factors, such as:
- the type of leukaemia
- the patient's age, health status and fitness levels
Chemotherapy is the mainstay of treatment and is planned in two stages: induction and consolidation. Chemotherapy and other common treatment pathways are outlined below:
Leukapheresis
Leukapheresis is a way of removing white cells from the bloodstream when the white count is very high. Other cells and plasma are returned to the body via another line once excess white cells have been removed.
Induction chemotherapy
Induction chemotherapy aims to kill leukaemia cells so that remission is achieved. However, more than one course of treatment may be needed before this can be achieved. Patients not entering complete remission after induction therapy are at high risk for failure of treatment and should be considered candidates for allogeneic transplantation
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NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 1: Procedures for assessing people’s needs for person-centred care
1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages
1.2 physical health and wellbeing
Part 2: Procedures for the planning, provision and management of person-centred nursing care
11. Procedural competencies required for best practice, evidence-based medicines administration and optimisation
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Resources
American Cancer Society. What are the risk factors for acute
myeloid leukaemia. 2018. www.cancer.org/cancer/acute-myeloid-leukemia/causes-risks-prevention/risk-factors.html
(accessed 19 January 2024)
Cancer Research UK. Bone marrow or stem cell transplants
for acute myeloid leukaemia (AML). 2020. https://www.cancerresearchuk.org/about-cancer/acute-myeloid-leukaemia-aml/treating-aml/bone-marrow-stem-cells-transplant-aml
(accessed 19 January 2024)
Cancer Research UK. Acute myeloid leukaemia statistics.
2018. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/leukaemia-aml#heading-Zero (accessed 19 January 2024)
Cleveland Clinic. Multi-gated acquisition scan. 2022. https://my.clevelandclinic.org/health/diagnostics/17247-multigated-acquisition-scan-muga (accessed 19 January 2024)
Cleveland Clinic. Acute myeloid leukaemia (AML). 2023. https://my.clevelandclinic.org/health/diseases/6212-acute-myeloid-leukemia-aml (accessed 19 January 2024)
Davis AS, Viera AJ, Mead MD. Leukaemia: An overview for
primary care. Am Fam Physician. 2014;89(9):731-738
Fey M, Dreyling M, ESMO Guidelines Working Group.
Acute myeloblastic leukaemia in adults: EMSO clinical
recommendations for diagnosis, treatment and follow
up. Ann Oncol. 2009;20(Suppl 4):100–101. https://doi.org/10.1093/annonc/mdp141
GP Notebook. World Health Organisation classification of acute myeloid leukaemia. 2018. https://gpnotebook.com/pages/haematology/classification/world-health-organisation-classification-of-acute-myeloid-leukaemia (accessed 19 January 2024)
Knott L. Acute myeloid leukaemia. 2022. https://patient.info/doctor/acute-myeloid-leukaemia-pro (accessed 19 January 2024)
The National CML Society. What are
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