Acute myeloid leukaemia: Teenagers and young adults

Acute Myeloid Leukaemia in young adults Illnesses and conditions Cancer Cancer types in teenagers and young adults Acute myeloid leukaemia: Teenagers and young adults Acute myeloid leukaemia: Teenagers and young adults Introduction Leukaemia, blood tests and bone marrow Tests for AML Treating AML Introduction This section is for teenagers and young adults and is about a type of cancer called acute myeloid leukaemia (AML). The other main type of leukaemia that can affect teenagers and young adults is acute lymphoblastic leukaemia . For information about AML in people of all ages,read our general AML section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control. Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help fight infection (white cells) carry oxygen from the lungs around the body (red blood cells) stopcuts bleeding by clotting blood (platelets) Symptoms Many of the symptoms of AML are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired because of too few red blood cells (anaemia) bruises or bleeding you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats you may have a high temperature without any obvious cause, such as an infection headaches and blurred vision because of too many white blood cells breathlessness because of too many white blood cells. Causes Its not knownexactly what causes AML. Research is going on to try to find out. We do know some things might increase the risk of AML: some genetic conditions, like Downs Syndrome (agenetic condition is something you are born with) some non-cancerous conditions of the bone marrow, such as aplastic anaemia or myelodysplastic syndromes If youre worried about AML If you think you might have any of the symptoms of AML, you should go to your GP. Theyll talk to you about your symptoms, examine you and can arrangetests or refer you to see a specialist.Remember that the symptoms can be caused by other things, but its important to go and get checked if you are worried. Leukaemia, blood tests and bone marrow To understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, which is like a blood cell factory inside bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are3 main types of blood cells: white blood cells which help fight infection red blood cells  which carry oxygen from the lungs around the body platelets  which clot blood to stop cuts bleeding The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (theyre immature). The main job of blast cells is to make more blood cells like themselves. They cant do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until theyve matured into fully-developed blood cells. Once blood cells are mature, theyre ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever theyre needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from2 types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. The most common types in teenagers and young adults are AML and ALL: acute myeloid leukaemia(AML) is leukaemia that starts from abnormal myeloid cells acute lymphoblastic leukaemia (ALL) is leukaemia that starts from abnormal lymphoblasts There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more,contact Macmillan . We also have more information about: symptoms and causes of AML having tests for AML being treated for AML If youre looking for information about ALL in people of all ages, read general AML section. Tests for AML You should speak to your GP as soon as possible if you think you have some of the symptoms of AML. But remember that the symptoms of AML can be caused by other things. Visiting your GP Your GP will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so youll need to have a blood test to help diagnose acute myeloid leukaemia (AML). If you have AML, a blood test will usually find leukaemia cells and youll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood disorders. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: blood tests  youll need more blood tests even if youve had some already tolook at the changes in the leukaemia cells and help the doctors decide on the best treatment for you; these tests may be called cytogenetics and immunophenotyping bone marrow test to count the numbers of leukaemia cells in the bone marrowand get send samples for cytogenetic and immunophenotyping testing lumbar puncture a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells chest X-ray  this may also be done to see if there are any swollen lymph nodes (glands) in your chest If you have AML, you might need a few more tests to check how your body is working in general. These could be blood tests, an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, or an echocardiogram (which is an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them what will happen, how youll feel and when youll get the results can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a cancer support specialist on Macmillans free helpline . We also have more information about: symptoms and causes of AML being treated for AML leukaemia, blood cells and bone marrow If youre looking for information about AML in people of all ages, read our general AML section. Treating AML The main treatment for acute myeloid leukaemia (AML) is chemotherapy. This means having anti-cancer drugs to destroy the leukaemia cells. Youll also have drugs called steroids, which help the chemotherapy to work. The treatment for AML is pretty intensive at times and can cause unpleasant side effects. But youll be in hospital when youre most likely to feel unwell, and the staff can help if things get tough. Dont feel you have to be brave. Be honest about how youre feeling with your doctors and nurses. They can give you medicines to help you feel better. There are different phases of treatment for AML: getting rid of the leukaemia  remission induction keeping the leukaemia away consolidation and delayed intensification therapy central nervous system (CNS) therapy (mainly for teenagers under 16) Very often, treatment is given as part of a clinical trial or research study, but it will be your decision whether to take part in the trial or not. Clinical trials help doctors to keep improving treatment for leukaemia. You usually start chemotherapy pretty quickly after finding out that you have AML. Youll be in hospital for your treatment to begin with.If youre 18 or younger, youll be treated in a specialist Principal Treatment Centre (PTC) for teenage and young adults (TYA).If youre 19 or older, youll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. Most chemotherapy for AML is given into the bloodstream (intravenously). So youll have a line put into one of your main veins to make it easier for you to have intravenous chemotherapy. There are different kinds of lines. Youll also be given chemotherapy into the fluid around your spinal cord and brain. This is to get rid of any leukaemia cells that might be hiding there. This type of treatment is called central nervous system (CNS) therapy. Having chemotherapy can be hard, but the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And youll be given medicines to help you feel less sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when youll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital for long periods can be frustrating, especially when you miss out on stuff happening at school, college, university or work or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. Youll be given chemotherapy to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. You have chemotherapy over a few days, then you have a few weeks off so that your body can recover from any side effects. The days you have the chemotherapy and the rest period afterwards is called a cycle. Youll usually have4 cycles of chemotherapy overall with2 courses in the induction phase. Some people might also need to have a bone marrow transplant. This normally happens after 2 cycles of chemotherapy. Youll probably need to stay in hospital most of the time that youre having remission induction. This is so that the doctors can check how things are going. Chemotherapy drugs Drugs you may have include: cytarabine (Ara-C) daunorubicin, doxorubicin or idarubicin etoposide thioguanine Side effects Different chemotherapy can cause different side effects. There is information about the specific ones inMacmillans chemotherapy section . As well as the chemotherapy drugs, youll be given other drugs to: help prevent you from feeling sick or being sick help prevent infections protect your kidneys as sometimes when lots of leukaemia cells are destroyed at once it can cause kidney problems Youll probably also need blood and platelet transfusions to top up the numbers of red cells and platelets in your blood. Chemotherapy can cause side effects. Most of them are short-term (temporary) and gradually disappear once treatment stops. The most common side effects are: being more at risk of infections feeling sick hair loss a sore mouth Sometimes side effects can be long-term. For example, some chemotherapy treatments can affect fertility (your ability to have a baby). If you are a young man, you will be offered the chance to store sperm before chemotherapy is started. There may be other late effects of treatment and your specialist can talk to you about this. Remission induction is pretty intense treatment and youll probably feel a bit wiped out sometimes. Youll need to stay in hospital for most of the time and you might not have the energy to do much. You might feel fed up, tearful or irritable. Its normal to feel like this. Its hard to be in hospital and you might worry about losing touch with your friends or falling behind at school or college. It can help to talk about this with a friend, doctor, nurse or counsellor. Keeping the leukaemia away (post-remission treatment) This phase of treatment is sometimes also called consolidation or intensification treatment. Its given to prevent the leukaemia from returning (known as a relapse). When youre in remission, it means the doctors cant see any leukaemia cells in your blood or bone marrow samples under the microscope. But there may still be leukaemia cells hiding in your body, so further treatment is needed to get rid of these cells. You start post-remission treatment soon after you complete remission induction. Youll usually have2 courses of treatment. You might be given the same chemotherapy drugs youve had before (perhaps at similar or higher doses) or you might be given different chemotherapy drugs. When your doctors decide what chemotherapy treatment plan to give you, they will take into account: how well your leukaemia responded to the first lot of treatment (remission induction) the results of the tests that were done when you were diagnosed The following drugs may be used to treat you: cytarabine (ara-C) methotrexate Central nervous system therapy (CNS) You usually wont need this treatment if youre 16 or over. But if youre under 16, youll probably have it. CNS therapy is given to get rid of any leukaemia cells that might be in the brain or spinal cord. (The CNS or central nervous system is the name for the brain and spinal cord.) CNS therapy involves giving chemotherapy into the fluid, called cerebrospinal fluid or CSF, around the spinal cord and brain. Its a bit like having a lumbar puncture but with chemotherapy added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then they inject chemotherapy into the CSF. The CSF will carry the chemotherapy around your CNS so it can reach any leukaemia cells that might be there. Youll have a lumbar puncture before you start treatment to check for leukaemia cells in the CSF. If there is no sign of leukaemia cells, youll have2 lots of CNS therapy,1 after each cycle of remission induction therapy. If there are leukaemia cells in the CSF, youll have CNS therapy twice a week until all traces of leukaemia cells in your CSF have gone. Youll then have2 more lots of CNS therapy just to make sure. For CNS therapy for AML, youll have chemotherapy drugs called methotrexate and cytarabine and a steroid called hydrocortisone. Side effects The most common side effect is feeling sick but you can be given anti-sickness treatment to help this. Rarer side effects include a headache, dizziness, tiredness or blurry vision for a few hours afterwards. We also have more information about: symptoms and causes of AML having tests for AML leukaemia, blood cells and bone marrow If youre looking for information about AML in people of all ages, read our general AML section.