Acute Myeloid Leukemia (AML)

Acute myeloid leukemia (AML) is a rare blood cancer that affects myeloid cells. These are cells in your bone marrow that make red and white blood cells and platelets. The condition is also known as acute myelogenous leukemia.

With acute myeloid leukemia, abnormal myeloid cells called myeloid blasts multiply uncontrollably to fill up your bone marrow. The blasts crowd out healthy blood cells and platelets. Without new healthy blood cells, your body doesn’t have what it needs to function.

There are several subtypes of AML:

• Myeloid leukemia: This type affects your neutrophils, the most common type of infection-fighting white blood cells.
• Acute monocytic-5 leukemia (AML-M5): This is an aggressive blood cancer. It causes symptoms that worsen quickly.
• Acute megakaryocytic leukemia (AMLK): This type affects your red blood cells and platelets. Red blood cells help carry oxygen throughout your body. Platelets make blood clots that control bleeding.
• Acute promyelocytic leukemia (APL): This is cancer in your promyelocytes (immature white blood cells) that keeps these cells from developing.

Acute myeloid leukemia affects about 5 in 100,000 adults annually. It’s more common in adults aged 65 and older. Chemotherapy often puts it into remission. This is when your symptoms go away and tests don’t find cancer signs. But it can come back. An allogeneic stem cell transplant is the only cure.

Symptoms of acute myeloid leukemia

This condition may cause flu-like symptoms, such as body aches and fever that don’t go away. You may develop other symptoms that quickly get worse, including:

• Back, belly or bone pain
• Chills, fever or night sweats
• Easy bruising or bleeding, like frequent nosebleeds and bleeding gums
• Fatigue or weakness
• Headaches
• Loss of appetite
• Shortness of breath (dyspnea)
• Sores or wounds that don’t heal
• Swollen lymph nodes
• Tiny red spots on your skin (petechiae)

Acute myeloid leukemia causes

Experts believe changes (mutations) in certain genes or chromosomes set off a chain of events that lead to AML. Some people have inherited disorders with genetic changes that increase their risk. But most changes happen after you’re born. Certain factors may increase your risk, including:

• Age: More than half of all people are 65 or older when they’re diagnosed.
• Tobacco use: Smoking and exposure to secondhand smoke are known risk factors.
• Carcinogen exposure: Long-term exposure to chemical carcinogens like benzene and formaldehyde may increase your risk.
• Chemotherapy: Some chemo medications may cause AML that develops years after you finish treatment.
• High-dose radiation: AML may develop after exposure to very high radiation doses, like an atomic bomb blast or nuclear reactor incident. Radiation therapy for cancer may increase your risk.

Complications of acute myeloid leukemia

With AML, there’s less room in your bone marrow for healthy red and white blood cells and platelets. Low levels of blood cells and platelets can lead to blood disorders like:

• Anemia (low levels of red blood cells)
• Thrombocytopenia (low platelet levels)
• Pancytopenia (low blood cell and platelet levels)

Later, abnormal cells may spill into your bloodstream and travel to your central nervous system, brain and spinal cord.

How doctors diagnose acute myeloid leukemia

A healthcare provider will ask about your symptoms, including issues that come back. They’ll check your lymph nodes, liver and spleen for swelling. They may do tests, including:

• Complete blood count (CBC)
• Peripheral blood smear
• Bone marrow biopsy
• Lumbar puncture

They may do the following genetic tests to identify the subtype:

• Immunohistochemistry
• Flow cytometry
• Karyotype test
• FISH test

How is acute myeloid leukemia treated?

Chemotherapy is often the first treatment. You’ll receive cancer medication in three steps:

1. Induction therapy: This treatment kills cancer cells and puts the condition into remission. Treatment typically lasts four to six weeks. You’ll need to stay in the hospital during induction therapy.
2. Consolidation therapy: This is treatment to kill any remaining cancer cells. You’ll receive chemotherapy five days a month for three to four months. You won’t need to stay in the hospital for this therapy.
3. Maintenance therapy: This involves lower chemotherapy doses that you’ll receive for the next two to three years. This treatment is designed to keep AML in remission.

There are other treatments if chemotherapy isn’t effective or if AML comes back:

• Targeted therapy: You may have monoclonal antibody therapy if chemotherapy isn’t effective. It’s also an option if cancer comes back after chemotherapy. This treatment targets specific genetic changes in the cancer cells.
• Allogeneic stem cell transplant: With this treatment, you receive healthy stem cells from a donor. The transplanted cells make new ones in your bone marrow. A stem cell transplant can cure this condition. But this procedure isn’t an option for everyone who has AML.

Try to keep in mind: Treatment is a marathon, not a sprint. It can be exhausting to keep up your daily routine while you receive treatment. Family and friends may be able to help with chores and errands. That support can give you time to rest and recharge. It can also give you time for self-care, like meditation, which can help you manage stress.

When should I see my healthcare provider?

If you have AML, talk to your provider if your symptoms get worse or you have new ones. Chemotherapy and targeted therapy may cause side effects. Let your provider know if any side effects are more severe than you expect. They may try other treatments or dosages.

What can I expect if I have acute myeloid leukemia?

Experts with the National Cancer Institute (U.S.) estimate chemotherapy puts the condition into remission for 6 to 7 out of 10 people. Remission may be permanent for about 5 out of those 10 people. That’s why you’ll have follow-up exams after you finish treatment.

AML that comes back usually develops within the first few years after treatment. You’ll probably have regular monthly checkups for the first year, then less often. Your checkups may involve blood tests and/or bone marrow exams.

It’s normal to feel anxious about tests to see if AML comes back. Some people have “scan anxiety” — anxiety that makes it hard to sleep or focus before tests and while waiting for results. That may be especially true if you have a condition that can come back. Some ways to manage scan anxiety include:

• Understanding what the tests check and when you’ll have results
• Managing stress with activities like meditation or being active
• Joining a support group — it can help to talk with others who are going through the same experience

What are AML survival rates?

Survival rates vary depending on your age at diagnosis. For example, 4 out of 10 people aged 40 to 64 are alive five years after their diagnosis. The survival rate drops to 2 out of 10 people aged 65 to 74.

Survival rate information can be worrisome. Keep in mind that these rates are estimates based on what experts know about acute myeloid leukemia. Ask your healthcare provider to explain what survival rate data means in your situation.