Final Stages of AML in the Elderly

Symptoms

Acute Myeloid Leukemia, or AML, is a rapidly progressing disease specific to elderly people. AML attacks the DNA of red blood cells while they are forming in the bone marrow. The body is then unable to produce enough red blood cells and platelets to sustain life. Early symptoms of AML are also symptoms of aging. Early symptoms include lethargy, bruising easily and shortness of breath. A person with later stage AML will experience unexplained internal and external bleeding. A bone marrow biopsy will confirm the diagnosis of AML.

Treatment

Elderly people often choose to forgo traditional treatments and let nature take its course. Treatment options for AML include chemotherapy and bone marrow stem-cell transplant. Elderly people are more likely to experience chemotherapy toxicity, which is harder to live with than AML. Chemotherapy toxicity can be fatal in and of itself. Elderly patients are more likely to experience chemo-related neutropenia, a condition that causes the body to attack neutrophils. An AML patient who also has neutropenia has no real ability to fight infection. AML patients must receive intensive chemotherapy before a bone marrow stem-cell transplant can be performed.

Prognosis

The final stage of AML is, unfortunately, death. The Merck Manual online states that most patients die within a few weeks to a few months after diagnosis. Elderly AML patients often die suddenly from internal bleeding. Other patients survive for a while with frequent blood transfusions. When the patient does not have an advanced directive, the family needs to determine which measures the doctors should take to sustain life. Some patients and families choose to treat just the pain, so the patient may be comfortable during the final moments of life. Hospice volunteers and nurses can help the dying patient maintain dignity during the process of death.

Dying Process

Signs that death is imminent are the same as with any other disease. Loss of appetite is the first signal that the AML patient may be dying. A person who is dying will sleep more often than not. AML patients in their final stages experience labored breathing. Each breath may be quite audible. At this point, bone pain will be severe. Doctors may suggest sedating the patient with narcotics such as morphine to ease the pain. Bleeding through the gums or around the gum-line can suggest the patient is at risk for internal bleeding. Internal bleeding in late-stage AML patients cannot be treated without causing a new bleed. Symptoms of a lethal, internal bleeding include shivers, confusion, loss of consciousness and death.

Alternate Names

The Mayo Clinic website states that acute myeloid leukemia is also called acute myeloblastic leukemia, acute myelogenous leukemia, acute granulocytic leukemia and acute nonlymphocytic leukemia 1.