Acute myeloid leukemia - adult

  • Definition
    • Acute myeloid leukemia (AML) is cancer that starts inside bone marrow. This is the soft tissue in the center of bones that helps form all blood cells. The cancer grows from cells that would normally turn into white blood cells.

      Acute means the disease grows quickly and usually has an aggressive course.

  • Alternative Names
    • Acute myelogenous leukemia; AML; Acute granulocytic leukemia; Acute nonlymphocytic leukemia (ANLL); Leukemia - acute myeloid (AML); Leukemia - acute granulocytic; Leukemia - nonlymphocytic (ANLL)

  • Causes
    • AML is one of the most common types of leukemia among adults.

      AML is more common in men than women.

      People with this type of cancer have many abnormal immature cells inside their bone marrow. The cells grow very quickly, and replace healthy blood cells. The bone marrow, which helps the body fight infections and makes other blood components, will someday stop working correctly. People with AML are more likely to have infections. They also have an increased risk of bleeding as the numbers of healthy blood cells decrease.

      Most of the time, a health care provider cannot tell you what caused AML. However, the following things can lead to some types of leukemia, including AML:

      • Blood disorders, including polycythemia vera, essential thrombocythemia, and myelodysplasia
      • Certain chemicals (for example, benzene)
      • Certain chemotherapy drugs, including etoposide and drugs known as alkylating agents
      • Exposure to certain chemicals and harmful substances
      • Radiation
      • Weak immune system due to an organ transplant

      Problems with your genes may also cause development of AML.

  • Symptoms
  • Exams and Tests
    • The provider will perform a physical exam. There may be signs of a swollen spleen, liver, or lymph nodes. Tests done include:

      • A complete blood count (CBC) may show anemia and a low number of platelets. A white blood cell count (WBC) can be high, low, or normal.
      • Bone marrow aspiration and biopsy will show if there are any leukemia cells.

      If your provider learns you do have this type of leukemia, further tests will be done to determine the specific type of AML. Subtypes are based on specific changes in genes (mutations) and how the leukemia cells appear under the microscope.

  • Treatment
    • Treatment involves using medicines (chemotherapy) to kill the cancer cells. Most types of AML are treated the same way in the beginning, with more than one chemotherapy medicine.

      Chemotherapy kills normal cells, too. This may cause side effects such as:

      Other supportive treatments for AML may include:

      • Antibiotics to treat infection
      • Red blood cell transfusions to fight anemia
      • Platelet transfusions to control bleeding

      A bone marrow (stem cell) transplant will likely be done after the first or second round of chemotherapy. This decision is decided by several factors, including:

      • Your age and overall health
      • How high your white blood cell count was
      • Certain genetic changes in the leukemia cells
      • The availability of donors
  • Support Groups
    • You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

  • Outlook (Prognosis)
    • When a bone marrow biopsy shows no evidence of AML, you are said to be in remission. Complete remission occurs in most patients. How well the person does depends on the overall health and the genetic subtype of the AML cells.

      Remission is not the same as a cure. More therapy is usually needed, either in the form of more chemotherapy or a bone marrow transplant.

      With treatment, younger people with AML tend to do better than those who develop the disease at an older age. The 5-year survival rate is much lower in older adults than younger people. Experts say this is partly due to the fact that younger people are better able to tolerate strong chemotherapy medicines. Also, leukemia in older people tends to be more resistant to current treatments.

      If the cancer does not come back (relapse) within 5 years of the diagnosis, you are likely cured.

  • When to Contact a Medical Professional
    • Call for an appointment with your provider if you:

      • Develop symptoms of AML
      • Have AML and have a fever that will not go away or other signs of infection
  • Prevention
    • If you work around radiation or chemicals linked to leukemia, always wear protective gear.

  • References
    • Appelbaum FR. Acute leukemias in adults. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 98.

      National Cancer Institute. PDQ Adult acute myeloid leukemia. Updated January 1, 2016. Accessed July 11, 2016.

      National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): acute myeloid leukemia. Updated June 29, 2016. Version 2. 2016. Accessed July 11, 2016.