What is the patho physiologyand prognosis of acute myeloblastic leukemia type 4?

March 07 22:38 2019 Print This Article

The cells which cause malignancy are the myeloblats. In the normal process of hematopoietic the myeloid precursor cells are the cells which form the myeloblasts. The normal myelo blast can form the mature white blood cells. In the case of AML a single myeloblast can accumulate the genetic changes which freeze the cell in the immature form and prevent the differentiation. It is not the sole factor which gives rise to leukemia. It is combined with the other mutations and disturbs the proliferation of gene which results in the uncontrolled growth of the immature clone of cells which lead to the clinical entity of AML.

The diversity of the AML is due to the leukemic transformation which can occur at a number of different steps along the differentiation path. The different classification systems can identify the characters and behavior of leukemic cells which depend on the stage at which the differentiation was stopped. The clinical signs of this disorder occur as a result of the leukemic clones of cell. They affect the normal development of the blood cells in the bone marrow. There are cyto genetic abnormalities seen in the patients with AML.

They have a great prognostic significance. The trans location of the chromosome encodes abnormal fusion proteins. It involves the transcription factors whose altered properties can cause arrest in the differentiation. In the case of pro myelocytic leukemia the process of translocation forms a fusion protein. It binds to the retinoic acid receptor element in the promoters of many myeloid specific genes which inhibit the differentiation. The symptoms of AML are due to the low number of normal blood elements. In few cases patient can develop a solid tumor of the cells which are present outside the marrow and can lead to many symptoms. It depends on the location.

What is the prognosis of acute myeloblastic leukemia type 4?

This disorder is curable and it depends on the multiple prognostic factors. The single most important prognostic factor in AML is the cyto genetics. It tells us about the chromosomal structure of the cell. Some of them are associated with a good outcome. In the case of trans location in acute pro myelocytic leukemia. Around 50 percent of the patients have normal cyto genetics and they come under intermediate risk group. The other cyto genetic abnormalities are linked with the poor prognosis and have a high risk of relapse. The first publication which addresses the cyto genetics and prognosis was published in the year 1998 by a MRC trial.

In the favorable risk category the 5 year survival rate is 70 percent and the relapse rate is 33 percent. In the intermediate risk category the 5 year survival rate is 48 percent and the relapse rate is 50 percent. In the adverse risk category the 5 year survival rate is 15 percent and the relapse rate is 78 percent. After some time the different oncology groups and leukemia groups published the overlapping lists of cyto genetic prognostication in leukemia.

The AML may arise from the myelo proliferative disorder or the pre existing myelo dysplastic syndrome. These are also known as the secondary AML and have a worse prognosis. They also have a high rate of unfavorable cyto genetic abnormalities. The other prognostic markers include the elevated levels of lactate dehydrogenate which were present in the individuals age 60 and above and have a poorer outcome.

The general physical condition and the activity level of the patient play a very crucial role in it. FLT3 internal tandem duplication plays a role in the poorer prognosis of AML. The long term survival cannot be reached by the treatment of patients with the aggressive therapy like stem cell transplantation. It is not of clinical significance. One can also see its association with the leukostasis.

The researchers are investigating the clinical significance of c KIT mutations in AML. These are prevalent and significant clinically as the availability of tyrosine kinas inhibitors can block the activity of c KIT. The other genes being investigated as the prognostic factors include the BAALC and ERG. The cure rates in the clinical trials have been less than 50 percent. It includes mainly the younger patients which can bear the aggressive therapy. In the elderly patients the cure is going to be lower and the cure rates for pro myelocytic leukemia can be as high as 98 percent.

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