Bone Marrow Transplant for AML in India
Bone Marrow Transplant for AML in India-BMT (Bone Marrow Transplant) or Hematopoietic stem cell  transplant is newer medical Intervention for treating hematological malignancies (Blood Cancers) and non malignant medical conditions in children.In this blog,we are discussing the the disease AML,how AML is diagnosed,what are the classific
ation method for AML, treatment choices for AML and
Bone Marrow Transplant for AML in India.
What are Indications for BMT in Children?
Bone Marrow or Hematopoietic Stem cell transplant is indicated in certain hematological malignancies as well as non malignant medical conditions in Children.
The major indications for BMT in children because of blood cancers are:
Acute Myeloid Leukemia (AML)
Acute Lymphoblastic Leukemia (ALL)
The non malignant medical conditions requiring BMT are:
Sickle cell disease and Thalassemia.
Aplastic Anemia or other Bone marrow Failure Syndrome.
Immune deficiency diseases,inherited metabolic disorder and others.
Bone Marrow Transplant for AML in India
In this Blog we will highlight the need of Bone Marrow Transplant for AML ( Acute Myeloid Leukemias)
Acute Myeloid Leukemia (AML)Â is a kind of blood cancer.It may consists of multiple disorders involving replacement of healthy bone marrow with abnormal primitive hematopoietic cells.
It may affect both adults and children.AML can affect children of any age and sex.
A subdivision of AML helps the treating doctor chose the best treatment option and ensure better treatment outcome.
AML can be subdivided in a cluster of diseased medical conditions.The most common and widely used classification for sub division of AML is
French-American-British system also known as
FAB.
Another newer subdivision recommended by World Health Organization known as
WHO system is also prevalent.
As per FAB ,AML subdivision is as follows:
M0 - AML with minimal evidence of myeloid differentiation.
M1 - AML without maturation.
M2 - AML with maturation.
M3 - Acute promyelocytic leukaemia (APL)
M4 - Acute myelomonocytic leukaemia
M5 - Acute monocytic/monoblastic leukaemia
M6 - Acute erythroleukemia
M7 - Acute megakaryoblastic leukaemia
Subdivisions of AML as per WHO System:
(Rarely used in pediatrics patients)
AML with characteristic cytogenetic translocations.
AML with multilineage dysplasia.
AML and myelodysplasia syndromes secondary to therapy.
AML not otherwise categorized.
Signs and Symptoms of AML in children: Bone Marrow Transplant for AML in India
As we have discussed in earlier slides that AML is not one
disease but a cluster of associated medical conditions.
The signs and symptoms can also be classified according to diseased medical condition.
Symptoms due to deficiency of normal functioning cells:
Cytopenia,Anemia.Hemorrhage and fever.
Symptoms due to infiltration of abnormal leukemic cell:
Extramedullary infiltration,Mediastinal mass which may cause superior Vena Cava Syndrome or respiratory insufficiency.
Abdominal masses causing pain or obstruction in GI or urogenital tracts.
Gingival hyperplasia.
CNS infiltration.
Causes and factors responsible for pediatric AML:
Causes and factors for AML in children are still being studied.Nothing concrete can be said but the things which
may be linked to AML in children are:
Children with genetic disorders such as downs syndrome or Li Fraumeni Syndrome are considered to be at a
higher risk of developing Pediatric Leukemia.
Although very small,but children with siblings having AML stand a risk of having AML.
Children suffering from Non malignant medical conditions like Aplastic anemia and MDS (myelodysplastic syndrome)
also stand the danger of getting AML.
Link between exposure to radiation,living nearby high voltage power lines and certain chemicals and pesticides are being studied.
Treatments for AML| Bone Marrow Transplant for AML in India
The treatment for AML is guided with intention of destructio of the leukemic cells and enabling the bone marrow to produce normal cells and function in a normal way.
Chemotherapy is the back bone of AML treatment. A combination of chemotherapeutic or Anti cancer medicines are used for the optimum results and lower side effects.
The treatment of AML is multiphasic.
The first phase is usually called as
induction phase. The aim of induction phase is to destroy abnormal leukemic cells. Induction phase involves chemotherapy with combination chemotherapeutic agents for at least for two chemotherapy cycles.
A bone marrow test is conducted at the end of this phase to ensure that the child is free of leukemia.If there is no evidence of leukemia ,the child's condition is referred as being in remission.
Two more cycles of chemotherapy are given to child post the induction phase,to ensure destruction of any left over leukemic cell in blood or bone marrow and prevent any relapse.
Bone Marrow Transplant For AML in India:
Bone Marrow Transplant or BMT is recommended for treatment of AML when the disease has relapsed or the treating doctor feels that the child is at a higher risk for relapse.
Sometimes AML may develop in CNS ,that is spinal chord and brain and in such cases intrathecal chemotherapy is administered to child directly in spinal fluid.Sometimes radiotherapy to brain is also used in conjunction.
Dr Vikas Dua is Senior Consultant at DEPT. of Hematology and BMT at FMRI,Gurgaon,India.Artemis Hospital is well equipped and well manged for a complicated medical procedure like BMT.
