Acute Myeloid Leukemia (AML)
What is acute myeloid leukemia (AML)?
Acute myeloid leukemia (AML) is a blood cancer that starts in your bone marrow. As part of your skeletal system, this spongy tissue inside your bones produces blood cells. The bone marrow produces three types of cell lines:
- White blood cells.
- Red blood cells.
White blood cells help your body fight infections. In people with AML, the bone marrow makes abnormal white blood cells. These cancer cells are called myeloid blasts (myeloblasts).
AML quickly moves from the bone marrow into your bloodstream and can even involve other parts of your body. AML may spread to your lymph nodes, brain, liver, cerebral spinal fluid, skin, spleen or testicles as examples.
AML goes by different names. All of these are the same disease:
- Acute myelocytic leukemia.
- Acute myelogenous leukemia.
- Acute granulocytic leukemia.
- Acute nonlymphocytic leukemia.
- Acute promyelocytic leukemia
How common is acute myeloid leukemia (AML)?
AML is one of the most common types of leukemia (blood cancer) affecting adults. Close to 20,000 Americans will receive an AML diagnosis this year. The disease accounts for about 1 in 3 adult leukemia diagnoses. Still, AML is relatively rare. Only about 1% of all cancers are AML.
Children can also get AML. About 1 in 4 childhood leukemia diagnoses are AML.
Who might get acute myeloid leukemia (AML)?
Nearly half of people with AML are older than 65 at the time of diagnosis. The disease tends to affect men more than women. But people of all ages and genders can get the disease.
Certain factors increase risk, including:
- Blood disorders, including myelodysplastic syndromes (MDS) and essential thrombocythemia.
- Cancer treatments, including chemotherapy and radiation therapy.
- Chronic exposure to chemicals, such as benzene and formaldehyde.
- Family history of AML (although this is very rare).
- Genetic disorders, including Down syndrome, Klinefelter syndrome and Fanconi anemia.
- High-dose radiation exposure from a nuclear reactor accident or atomic bomb.
- Smoking, including exposure to secondhand smoke.
What are the types of acute myeloid leukemia (AML)?
There are many different subtypes of AML. Healthcare providers categorize the types based on how cancer cells form and which cells cancer affects.
Diagnostic tests tell providers the subtype. This information affects treatments. For example, acute promyelocytic leukemia (APL) is a subtype of AML. APL has genes that make it more sensitive to chemotherapy, and therapy for APL is distinct from AML treatments.
Symptoms and Causes
What causes acute myeloid leukemia (AML)?
The blood stem cells make up a small part of bone marrow. These stem cells develop into blood-forming cells and into white blood cells, red blood cells and platelets. The white blood cells include types of cells, including lymphocytes and myeloid cells.
The stem cell can develop a red blood cell that carries oxygen. The stem cell can become a white blood cell or it may become a platelet, which helps form blood clots and/or stop bleeding events.
In people with AML, the myeloid cells don’t develop normally into healthy cells due to a mutation or damage. Instead, in the case of AML, the cells turn into immature white blood cells called myeloid blasts (myeloblasts). These cells continue to grow rapidly and in an uncontrolled manner, disturbing the normal production of healthy cells. The uncontrolled growth can also cause damage by increasing your risk of bleeding and or other disorders (such as infection and stroke/heart attack) if the leukemia goes on unnoticed.
Leukemia cells (blasts) can build up in bone marrow, crowding out healthy cells. These diseased cells quickly move into your blood and other parts of your body.
What are the symptoms of acute myeloid leukemia (AML)?
AML causes these symptoms in adults and children:
- Easy bruising or bleeding, including frequent nosebleeds and bleeding gums.
- Feeling cold.
- Fever, night sweats or frequent infections.
- Loss of appetite and unexplained weight loss.
- Pale skin and anemia (low red blood cells).
- Shortness of breath (dyspnea).
- Swollen lymph nodes.
Diagnosis and Tests
How is acute myeloid leukemia (AML) diagnosed?
Your healthcare provider will perform a physical exam. They check for signs of bruising, bleeding or infection. Your provider will also see if you have an enlarged liver, spleen or lymph nodes.
You may get one or more of these tests:
- Blood tests: A complete blood count (CBC) checks your numbers of blood cells and platelets. A peripheral blood smear assesses if there are cancer cells present.
- Bone marrow biopsy: During a bone marrow biopsy, your provider removes a small piece of bone, marrow tissue and a liquid sample of the bone marrow. A lab analyzes these samples for cancer.
- Spinal tap: A spinal tap or lumbar puncture can determine if cancer is in the fluid around your brain or spinal cord. This test determines if cancer has spread to this area.
Management and Treatment
What are the complications of acute myeloid leukemia (AML)?
AML is fast-growing cancer. It can quickly spread to the body and can sometimes involve the spleen, skin, lymph nodes, liver or central nervous system.
How is acute myeloid leukemia (AML) managed or treated in adults?
Treatment options for AML include:
- Chemotherapy: Medication circulates throughout the bloodstream to slow or stop the growth of cancer cells. It’s the top treatment for AML. Some patients may need to be in the hospital for treatment, while others may have a chemotherapy treatment with infusion and oral medications to treat it at home. Some adults need maintenance chemotherapy for life.
- Targeted therapies: These drugs target certain parts of cancer cells to stop their growth. The specific treatment is based on the cancer’s mutations. Some types of AML respond well to this treatment.
- Monoclonal antibody therapies: Lab-made proteins attach to cancer cells to stop their growth. This drug can be used at the outset for some types of AML and it can also be used to treat AML that doesn’t respond to chemotherapy (called refractory cancer). It can also be used to treat cancer that comes back (relapse).
- Stem cell transplant: A stem cell or bone marrow transplant provides a new immune system that will recognize the cancer as bad and kill it. To proceed with a stem cell transplant, you must be in complete remission. You will need chemotherapy or radiation therapy first to make room in bones for the transplanted cells.
How is acute myeloid leukemia (AML) managed or treated in children?
Children with AML receive slightly different treatments and are treated by pediatric oncologists. The first treatment phase is induction therapy to try to bring about remission. Remission means your child shows no symptoms or signs of the disease and that the cancer cells can’t be detected in the marrow or the blood.
Induction therapy includes:
- Intrathecal chemotherapy: Your child receives an injection of chemotherapy directly into their spinal fluid. Intrathecal chemotherapy can be used to treat cancer that is identified in the cerebral spinal fluid and/or to prevent leukemia from going to that area. It can also be given as a preventative (prophylactic) measure. It can keep cancer cells from spreading to the spine, brain and other parts of the central nervous system.
- Monoclonal antibody therapies: In June 2020, the U.S. Food and Drug Administration (FDA) approved the use of gemtuzumab ozogamicin (Mylotarg®) in children ages 1 month and older with certain types of AML. It also helps children older than two who have cancer that comes back or doesn’t respond to treatment.
The second phase, consolidation therapy, lowers the risk of cancer recurrence (coming back). Treatments include:
- Chemotherapy: Your child may continue to get chemotherapy for several months, and this sometimes includes intrathecal chemo (but this is mostly for acute lymphocytic leukemia/ALL). Children typically don’t need to continue with chemotherapy after the disease is in remission after completing consolidation chemotherapy cycles.
- Stem cell (bone marrow) transplant: Your child receives an infusion of healthy cells from a donor. The donor may be a sibling or a matched unrelated donor.
How can I prevent acute myeloid leukemia (AML)?
There are no specific ways to prevent this disease. We don't know what causes AML.
Outlook / Prognosis
What is the prognosis (outlook) for adults who have acute myeloid leukemia (AML)?
Approximately 2 out of 3 adults with AML go into remission after getting chemotherapy. Remission means you don’t have disease symptoms. There are no detectable cancer cells in the bone marrow and the normal healthy cells are growing again.
Because AML often comes back, you may continue to get chemotherapy to destroy any remaining cancer cells and keep them away. Your healthcare provider may call this step post-remission (consolidation) chemotherapy. Up to half of people who get this treatment go into long-term remission. AML accounts for fewer than 2% of all cancer-related deaths.
If cancer comes back within 12 months of treatment, your provider may recommend a stem cell transplant if you are healthy enough to tolerate it. If you’ve relapsed, a bone marrow transplant is often the only chance for cure once the leukemia has gone back into remission.
What is the prognosis (outlook) for children who have acute myeloid leukemia (AML)?
Children respond better to AML treatments than adults. Almost all kids — up to 90% — go into remission after initial chemotherapy treatment. But they still need more chemotherapy (post-remission/consolidation therapy) to destroy any lingering cancer cells.
When should I call the doctor?
You should call your healthcare provider if you experience:
- Extreme fatigue.
- Fever or signs of infection.
- Unexplained bruising or bleeding.
- Weight loss.
What questions should I ask my doctor?
You may want to ask your healthcare provider:
- What type of AML do I have?
- What are my treatment options?
- What are the treatment risks and side effects?
- How can I manage treatment side effects?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most children with AML go on to lead normal full lives. In adults, the disease is more difficult to cure. Treatments can put cancer into remission so you have no signs of disease in your bone marrow and a return of the normal healthy cells. In some patients (especially older patients), cancer cells stay active and the AML can relapse. You may need treatments for life. Even during remission, you’ll need follow-up tests to check for signs of a relapse. Your healthcare provider can discuss the best treatments and care plan for the specific AML subtype that you have.
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