Transcription
Treatment of acute myelogenous leukemia, or AML. In the previous video, we have discussed acute myelogenous leukemia. Today, let's know how to manage it.
You know, treatment of any acute leukemia has an induction phase and consolidation phase. I'm talking about chemotherapy, not radiation. First, induction phase: we give chemotherapy, and high dose, to suppress all of the cell lines. But, the patient is now prone to infection. We can give myeloid growth factors. We can get rid of blood cells and platelets. Then, when everything normalized, i.e., remission, we can go to the consolidation phase. Fine. Then, bone marrow or stem cell transplant is the last resort, specific about AML.
So, induction phase: give cytosine arabinoside for seven days plus daunorubicin for three days; seven plus three equals ten. Consolidation: we use the same drugs. Allogeneic stem cell transplant, of course, we keep this for patients less than sixty years old. Why? Because young patients usually have better prognosis. Young patients have life in front of them. While young patients are healthier, so they are good candidates for chemotherapy, and we have limited resources; we don't have stem cell transplant for everybody.
Now, if there is the specific type, M3 acute promyelocytic leukemia, give vitamin A, also known as retinol, retinoic acid, or tretinoin, and check for DIC and check for differentiation syndrome.
There's a case for you: Your 50-year-old male patient had fatigue, mucosal bleeding. You discovered blasts in the blood; they had Auer rods. So, these are probably AML. Okay, they are telling us that it's AML. Fine. Started induction chemotherapy. Then, after 15 days, the patient still has an absolute neutrophil count of less than 500. This is so low; this is neutropenia. He has an increased risk for—and the answer is—say, bacterial pneumonias and enterocolitis. We call this neutropenic enterocolitis or typhlitis, and we'll talk about this in later videos.