Acute Myeloid Leukemia (AML)

What Is Acute Myeloid Leukemia?

Acute myeloid leukemia (AML) is a type of blood cancer. It starts in your bone marrow, the soft inner parts of bones. AML usually begins in cells that turn into white blood cells, but it can start in other blood-forming cells, as well.

With acute types of leukemia such as AML, bone marrow cells don't grow the way they're supposed to. These immature cells, called blasts, build up in your body.

You may hear other names for acute myeloid leukemia, including:

• Acute myelocytic leukemia
• Acute myelogenous leukemia
• Acute granulocytic leukemia
• Acute non-lymphocytic leukemia

If you don’t get treatment, AML can be life-threatening. It can spread quickly to your blood and to other parts of your body, such as your:

• Lymph nodes
• Liver
• Spleen
• Brain and spinal cord
• Testicles

How acute myeloid leukemia affects you depends on certain things, including how well it responds to treatment. Your outlook is better if:

• You’re younger than 60.
• You have a lower white blood cell count when you're diagnosed.
• You haven’t had other blood disorders or cancers.
• You don’t have certain gene or chromosome changes.

AML Causes and Risk Factors

Doctors often don’t know why someone gets AML. But some things may make you more likely to get it. Acute myeloid leukemia risk factors include:

• Smoking
• Coming into contact with certain chemicals such as benzene (a solvent that’s used in oil refineries and other industries and that’s found in cigarette smoke), pesticides, ionizing radiation, some cleaning products, detergents, and paint strippers
• Some chemotherapy drugs used to treat other cancers, such as cyclophosphamide, doxorubicin, melphalan, and mitoxantrone
• Exposure to high doses of radiation
• Certain blood conditions such as myeloproliferative disorders (for example, chronic myelogenous leukemia)
• A parent or sibling who had AML
• Certain genetic syndromes such as Down syndrome, trisomy 8, neurofibromatosis type 1, and Li-Fraumeni syndrome.

There’s no way to prevent AML, but you may lower your risk by not smoking and limiting your contact with chemicals.

AML Symptoms

Acute myeloid leukemia often begins with flu-like symptoms. You might have:

• Fatigue
• Fever
• Weight loss or loss of appetite
• Headaches
• Unusual bleeding or bruising
• Tiny red spots on your skin (petechiae)
• Swollen gums
• Swollen liver or spleen
• More infections than usual

AML Diagnosis

Your doctor will ask about your medical history. They’ll do a physical exam to look for signs of bleeding, bruising, or infection. You might have tests including:

• Blood tests. A complete blood count (CBC) shows how many of each type of blood cell you have. A peripheral blood smear checks for blast cells.
• Imaging tests. X-rays, CT scans, MRIs, and ultrasounds give a clearer picture of what’s going on inside you. They can help find infections or show when cancer has spread to other parts of your body.
• Bone marrow tests. Your doctor uses a needle to take a sample of marrow, blood, and bone from your hip or breastbone. A specialist looks at it under a microscope for signs of leukemia.
• Spinal tap. This is also called a lumbar puncture. Your doctor uses a needle to take some cerebrospinal fluid from around your spinal cord. A specialist checks it for leukemia cells.
• Genetic tests. A laboratory can look at your leukemia cells for gene or chromosome changes. The results will tell your doctor more about your AML so they can help you decide on the best treatment.

AML Treatment

Because acute myeloid leukemia moves quickly, it’s important to begin treatment right away. It will depend on several things, including what kind of AML you have, how far it’s spread, and your overall health.

You’ll have treatment in two phases:

• Remission induction therapy. This aims to kill leukemia cells in your blood and bone marrow so you go into remission, with no signs of the disease.
• Consolidation therapy. This is also called post-remission or remission continuation therapy. It’s intended to kill any remaining leukemia cells so the disease doesn’t come back.

You may have one or more types of treatment in either phase:

• Chemotherapy. Certain drugs can kill cancer cells or keep them from dividing. You might take these medicines by mouth, through an IV, or through a shot into another part of your body.
• Radiation. High-energy X-rays can also stop cancer cells. Your doctor might use a large machine to send radiation toward the cancer. Or they may insert a radioactive needle, seed, or wire into your body, on or near the cancer.
• Stem cell transplant. Because AML treatment can also kill healthy cells, you might get stem cells that can grow into blood cells. They might come from you or from another person.
• Targeted therapy. This uses drugs to attack specific genes and proteins involved with the growth and spread of cancer cells.
• Other medications. Drugs called arsenic trioxide (Trisenox) and all-trans retinoic acid (ATRA) target cancer cells in a type of AML called acute promyelocytic leukemia.

You might also choose to join a study of new treatments. These clinical trials often are a way to try new medicine that isn't available to everyone. Your doctor can tell you if one of these studies might be a good fit for you.

Before you sign up, ask for information on what’s involved and what the risks and benefits would be.

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