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Acute myeloid leukemia

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 develops 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

Acute myeloid leukemia (AML) is one of the most common types of leukemia among adults. This type of cancer is rare under age 40.

AML is more common in men than women.

Persons with this type of cancer have an abundance of 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, eventually stops working correctly. Persons with AML are more likely to have infections and have an increased risk of bleeding as the numbers of healthy blood cells decrease.

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

  • Blood disorders, including polycythemia vera, 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
  • Weakened immune system due to an organ transplant

Problems with your genes may also play a role in the development of AML.

 

Symptoms

Symptoms of AML may include any of the following:

Exams and Tests

The doctor will perform a physical exam. There may be signs of a swollen spleen, liver, or lymph nodes.

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 doctor 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 genetic changes or 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 drug.

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

  • Increased risk of bleeding
  • Increased risk of infection (your doctor may want to keep you away from other people to prevent infection)
  • Weight loss (you will need to eat extra calories)
  • Mouth sores

Other supportive treatments for AML may include:

  • Antibiotics to treat infection
  • Red blood cell transfusions to fight anemia
  • Transfusions of platelets to control bleeding

A bone marrow (stem cell) transplant will likely be done after your first or second round of chemotherapy. This decision is determined 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 you do depends on your 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 patients 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 persons. 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 health care provider if you develop symptoms of AML.

Call your health care provider if you 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, you should always wear protective gear.

References

Appelbaum FR. Acute leukemias in adults. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 98.

National Cancer Institute: PDQ Adult Acute Myeloid Leukemia Treatment. Bethesda, MD: National Cancer Institute. Date last modified 03/28/2014. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/adultAML/healthprofessional. Accessed May 29, 2014.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Acute Myeloid Leukemia. Version 2.2014. Available at: http://www.nccn.org/professionals/physician_gls/pdf/aml.pdf. Accessed May 29, 2014.


Review Date: 5/29/2014
Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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