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Acute myeloid leukemia is one of the four main types of leukemia.

About Marrow:

The marrow is the spongy center inside of bones where blood cells are made.

Blood cells are produced in the bone. They begin as stem cells. Stem cells become red cells, white cells and platelets in the bone. Then the red cells, white cells and platelets enter the blood.

Platelets form plugs that help stop bleeding at the site of an injury.

Red blood cells carry oxygen throughout the body. When the number of red cells is below normal, a medical condition called anemia. Anemia can cause fatigue or shortness of breath. It can make skin look pale.

White blood cells fight infection in the body. There are two main types of white cells: germ-eating cells (neutrophils and monocytes) and infection-fighting cells called "lymphocytes" (B cells, T cells and natural killer cells).

Plasma is the liquid part of the blood. It is mostly water. It also contains some vitamins, minerals, proteins, hormones and other natural chemicals.

About AML:

AML is a cancer that starts in the bone marrow. The probability of developing AML increases with age. But AML can occur at any age.

Reference values of a CBC:

Reference values below are for adults. They may be different from one laboratory to another, and in the case of children and adolescents.

• Red blood cell count (RBC, for its acronym in English)

Men: 4.5 to 6 million red blood cells per microliter of blood

Women: 4 to 5 million red blood cells per microliter of blood

• hematocrit (the percentage of blood formed by red blood cells)

Men: from 42% to 50%

Women: 36% to 45%

• Hemoglobin (the amount of pigment in red blood cells that carries oxygen)

Men: 14 to 17 grams per 100 milliliters of blood

Women: 12 to 15 grams per 100 milliliters of blood

• Platelet count

From 150.000 to 450.000 platelets per microliter of blood

• White blood cell count (WBC, for its acronym in English)

From 4.500 to 11.000 white blood cells per microliter of blood

• White blood (also called diff)

It shows the portion of the blood composed of different types of white blood cells.

The types of white blood cells that are counted are neutrophils, lymphocytes, monocytes, eosinophils and basophils

Generally, adults have about 60% neutrophils, 30% lymphocytes, 5% monocytes, eosinophil 4% and less than 1% of basophils in blood.

Causes and risk factors for AML:

AML starts with a change in a single cell in the bone marrow. Doctors do not know what causes most cases can not be prevented and is not contagious.

Certain factors may increase the risk of AML, such as: Signs and symptoms.

Many of the signs and symptoms of AML are also caused by other diseases. Most people with these signs and symptoms does not have AML.

A sign is a change in the body that the doctor sees in an exam or the test result.

A symptom is a change in the body that the patient can see or feel.

* Some signs and symptoms of AML are:

• Feeling sick: Be under normal bone marrow cells may cause pain in the legs, arms or hips. Patients may have a slight fever, enlarged lymph nodes or inflamed gums.

• Easier to get tired, shortness of breath, paleness: Having fewer healthy red blood cells can decrease energy levels. You can also make people feel out of breath when doing daily activities. Some people with fewer red blood cells may have a pale skin.

• Weight loss: Some people with AML lose weight because they eat less and / or because they use more energy.

• bruising or red spots the size of a pinhead: A low platelet counts can cause bruising patients presented more often or showing skin in tiny red spots called petechiae.

• Prolonged bleeding from minor cuts: A low platelet count can cause more prolonged bleeding or a slower healing of cuts.

Diagnosis:

It is important that patients receive the correct diagnosis. AML is diagnosed through blood tests and bone marrow.

• Blood Cell Counts: The doctor orders a test called a complete blood count (CBC, for its acronym in English) in which the number of red cells, white cells and platelets are counted. Usually, patients with AML have fewer red blood cells and platelets than expected.

• Examination of blood cells: The cells are stained and examined microscopically. This test is also called blood smears. A person with AML usually has too many cells of leukemic blasts in the blood. These cells do not function like normal cells.

• Bone marrow tests: Your doctor will do other tests to make the diagnosis of AML is correct. Tests called bone marrow aspiration and bone marrow biopsy to determine the percentage of AML cells in the bone marrow are made. A person with AML usually at least 20 percent of AML cells.

Types of AML

Knowing the type of AML patient helps the doctor plan treatment. Most people with AML have one of eight types: MO, M1, M2, M3, M4, M5, M6 and M7.

Most types of AML is the same. But patients with type M3 (acute promyelocytic leukemia, or APL) require a different treatment plan.

• Flow cytometry. Your doctor will order a test called flow cytometry to determine the type of AML you have.

• Cytogenetic analysis. Other tests for genetic changes in the cells are made. This test cell is called cytogenetic analysis. The results help the doctor plan treatment.

Chronic myeloid leukemia (CML) is known by several other names, including "chronic granulocytic leukemia" and "chronic myelocytic leukemia."

CML arises from a change (mutation) in the DNA of a single cell in the bone marrow. This mutation is "acquired" (not present at birth and is not spread).

The mutated marrow cell multiplies in various cells (CML). CML cells proliferate and better than normal cells survive; if left untreated, eventually outnumber normal cells. The typical result of the uncontrolled proliferation of CML cells in the bone is increased amount of these same cells in the blood. CML does not completely interfere with the development of red blood cells, white cells and platelets mature. As a result, chronic myeloid leukemia is usually less severe than acute leukemia.

Signs and symptoms:

Maybe people with CML have no symptoms at the time of diagnosis. These people may be diagnosed after a medical examination by another problem or as part of a regular checkup.

Signs and symptoms of CML tends to progress gradually. It is possible that people with CML:

• Feel tired and have breathing difficulties to perform daily activities

• have swollen spleen (which causes a feeling of heaviness in the upper left abdomen)

• Be pale due to anemia (a decrease in red blood cells)

• suffer from night sweats.

• Inability to tolerate warm temperatures.

• Weight loss.

Diagnosis and phases of CML:

Diagnosis:

In most cases, blood cells and bone marrow examined for diagnosis of CML. Several laboratory tests are used to screen blood and bone marrow cells, for example:

• CBC: The CBC measures the number and types of cells in the blood. With CML, decreases in hemoglobin and white blood cell count increases, often to very high levels. The number of platelets can rise or fall, depending on the seriousness of CML person. Examination of colored blood cells (dyed) with an optical microscope shows a characteristic pattern of white blood cells in people with CML: a small proportion of immature cells (leukemic blast cells and promyelocytes) and a higher proportion of white blood cells in process ripening and fully mature (myelocytes and neutrophils). Blast cells, promyelocytes and myelocytes not normally present in the blood of healthy people.

• Cytogenetic analysis: This test measures the amount and structure of chromosomes. Marrow samples are examined to confirm the results of blood tests to determine if there is a chromosomal abnormality such as the Philadelphia chromosome. The bone marrow tests, called "bone marrow aspiration" and "bone marrow biopsy", usually performed during the same procedure. In a bone marrow aspiration, a special needle into the hip bone to the bone to extract a liquid sample of cells is introduced. For a bone marrow biopsy, a special needle to remove a sample of bone marrow containing used. Both samples are examined under a microscope to look for chromosomal and other cell changes. The presence of the Ph chromosome (chromosome 22 shortened number) in bone marrow cells together with a high white blood count and other characteristic test results of blood and bone, confirm the diagnosis of CML.

• fluorescence in situ hybridization (FISH acronym). The bone marrow cells in about 90 percent of people with CML Ph chromosomes are detectable by cytogenetic analysis. A small percentage of people who show clinical signs of CML do not have detectable Ph chromosome by cytogenetic analysis, but almost always have positive results in terms of BCR-ABL on chromosome 22. FISH test is a more sensitive method to detect CML than standard cytogenetic tests that identify the Ph chromosome. FISH is a quantitative test that can identify the presence of BCR-ABL gene. Genes are composed of segments of DNA. The FISH assay uses specific substances binding to DNA to DNA fragments selected, in this case, ABL and BCR. The BCR and ABL probes are labeled with chemicals that emit, each a different color of light. The color shown in the chromosome containing the gene (typically chromosome 9 to chromosome 22 and ABL BCR), so that FISH can detect the piece of chromosome 9 that has moved to chromosome 22 in CML cells. Since FISH can detect the BCR-ABL cells found in blood, it can be used to determine if there is significant in the amount of circulating CML cells as a result of reduction treatment for CML.

• polymerase chain reaction (PCR, for its acronym in English). The BCR-ABL gene can also be detected by molecular analysis. A quantitative PCR test is a method of molecular analysis can be applied to blood cells or bone marrow. It is the most sensitive to identify and measure the BCR-ABL gene test.

Basically, the PCR test is increased or "amplified" small quantities of specific DNA or RNA fragments, to make it easier to detect and quantify. Thus, the BCR-ABL abnormality can be detected even when present in very low numbers of cells. The PCR test can detect abnormal cell approximately one million cells. Test Quantitative PCR was used to determine the relative amount of cells with BCR-ABL in the blood, and has become the most widely used type and relevant PCR test because of its high sensitivity and ability to quantify the level of disease present.

• You can also perform blood cell counts, bone marrow examinations, proof of FISH and PCR to monitor a person's response to therapy. Throughout the treatment, the number of red cells, white cells, platelets and CML cells is measured periodically after initiation of therapy.

Phases:

CML has three phases. In most cases, it diagnosed CML in "chronic" phase, although some patients are diagnosed in the "fast" and others in "blast crisis" phase. However, a small proportion of patients whose diagnosis and treatment are performed in the chronic phase of CML however progress to accelerated phase of CML. The advance from the chronic phase, which normally can be effectively controlled, to accelerated phase or blast crisis may result in additional genetic alterations in leukemic stem cells. Some additional chromosomal abnormalities can be identified by cytogenetic analysis. However, there appears to be other genetic changes in CML stem cells that can not be identified by laboratory tests currently available.

• Chronic phase: People with CML in chronic phase may have no symptoms at this stage, or the symptoms of CML before treatment can occur due to changes in blood cell counts or enlarged spleen. Symptoms of chronic phase, if present, are quickly resolved when people receive treatment. Initially, an effective therapy reduces the total count of white blood cells to near normal levels. The improvement in white blood cell count is accompanied by a reduction of expanded spleen size, improved hemoglobin concentration and the return of a sense of wellbeing. Bleeding and infectious complications are not common in chronic phase. Once treated, patients with CML in the chronic phase can fully resume their usual activities.

• Accelerated phase: Anemia may occur or progress to cause fatigue, white blood cell count may fall to very low levels or rise due to the accumulation of blast cells and, usually, lower platelet counts. The blast count in the blood and bone marrow usually increases during the accelerated phase (and rises further in blast crisis). You may increase the size of the spleen; the patient may lose your sense of well (at this stage, it is more common for people to feel sick), and may have more complications.

• blast crisis: In this phase, the number of blast cells increases both bone marrow and in the blood; the numbers of red cells, platelets and neutrophils can generally be very low, and the patient may suffer episodes of infection and bleeding as a result. Other commonly observed symptoms include fatigue, shortness of breath, abdominal pain, bone pain or inflammation of the spleen. Unfortunately, the blast crisis is similar to acute leukemia in terms of its effects on the patient. Transformation to blast crisis appears as acute lymphoblastic leukemia in approximately 25 percent of individuals, while in most appear as acute myeloid leukemia.

Treatment:

CML can not be totally cured with current drug therapies, but there have been several important advances in treatment in recent years and treatment options continue to evolve. With current drug therapies, the majority of people diagnosed with CML in chronic phase can expect to live a good quality of life. The goals of medical research on the LMC are to develop curative therapies and reduce side effects of treatment. The approach to treatment is individualized for each patient, based on the phase CML at diagnosis, age of the patient (particularly where the possibility of a stem cell transplant) and test results.

CML in chronic phase. The goal in treating people with chronic phase CML is to restore blood counts to normal levels, drastically reduce or completely eliminate CML cells and maintain an acceptable quality of life. Treatment usually restore blood cell counts to normal and remains normal or near these levels (not infrequently occurring mild reductions in blood cell counts). Spleen size decreases until it approaches its normal dimensions. Infections and abnormal bleeding are rare. Patients can return to do their daily activities. However, they should receive regular medical checkups, including blood cell counts and other tests to determine the extent and stability of cytogenetic and molecular remission. Periodic bone marrow examinations are necessary at the start of treatment, and often can be done less frequently over time; observing the response to treatment through periodic blood tests continued indefinitely. Furthermore, it is necessary to evaluate people from time to time to determine their tolerance to drugs, and as a result may have to adjust the dose.

Three drugs have been approved: imatinib mesylate (Gleevec), dasatinib (Sprycel®) and nilotinib (Tasigna) as initial therapy for chronic phase CML, all reasonable options for newly diagnosed patients.

Evaluation of treatment response

The evaluation of response to therapy with blood tests and bone marrow is a critical element of treatment for people with CML. In general, the greater the response to drug therapy, the longer the disease is controlled. Other factors affecting response to therapy include the stage of the disease and the characteristics of the person CML at diagnosis.

Thanks Béatrice and Juan Carlos foe your valuable distinguishing answer.

But still the query was what type of cells are predominating in each of these types? Becaouse >20% myeloblast is a common feature. But is it left shift in neutrophils is a prominant featureof AML than some what normal looking cell types in CML? 

Chronic myeloid leukemia

1. Constant leukocytosis in peripheral blood dysgranulopoiesis ranging between 20 and 200 x 109 / l with an absolute increase of mature granulocytes and the existence of immature granulocytes in all maturational stages and metamyelocytes predominantly myelocytes and promyelocytes with small number of and myeloblasts. The basophilia may be important relationship exists between the increase of basophils and terminal blast crisis.

2. In the chronic phase the number of red blood cells may remain normal or moderately decreased, and a third of patients have initial thrombocytosis.

3. Bone marrow is hypercellular with mieloeritroide ratio of 10 to 1 or higher, mainly at the expense of mielocíticos and metamielocíticos elements. histiocytes "navy" cells or "Gaucher-like" can be detected.

4. The bone marrow biopsy further detects the decrease or disappearance of marrow fat and an increase in reticulin fibers.

5. cytochemically activity F.A.G. It is greatly diminished or virtually absent in 90% of patients.

6. Often hyperuricemia, increased LDH and vitamin B12.

Acute Myeloid Leukemia

1-Almost always there is anemia and thrombocytopenia in the count, sometimes with extreme figures (normocytic anemia, normocrónica and hyporegenerative).

           2- Approximately half of patients present with neutrophil leukocyte numbers

Actually CML & AML are very different. Attention has to be given to the clinical history, how long the disease was present, splenomegaly, etc. The only time there is a problem is when a patient presents late, The may be a problem to differentiate CML Blast crisis & an AML with high total counts. Both have > that 20 % Blasts in Blood or BM. Look for the differentials, esp basophils & splenomegaly, more in CML blast crisis. Immunophenotyping will not help, as both will have blasts of specific lineage. Then get a karyotyping/ molecular study  done for CML