What is acute myeloid leukemia (AML)?

Acute myeloid leukemia (AML) is a cancer that occurs in your blood and bone marrow.

AML specifically affects the white blood cells (WBCs) of your body, causing them to form abnormally. In acute cancers, the number of abnormal cells grows rapidly.

The condition is also known by the following names:

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

There are an estimated 19,520 new cases of AML every year in the United States, according to the National Cancer Institute (NCI).

In its early stages, the symptoms of AML may resemble the flu and you may have a fever and fatigue.

Other symptoms can include:

AML is caused by abnormalities in the DNA that controls the development of cells in your bone marrow.

If you have AML, your bone marrow creates countless WBCs that are immature. These abnormal cells eventually become leukemic WBCs called myeloblasts.

These abnormal cells build up and replace healthy cells. This causes your bone marrow to stop functioning properly, making your body more susceptible to infections.

It’s not clear exactly what causes the DNA mutation. Some doctors believe it may be related to exposure to certain chemicals, radiation, and even drugs used for chemotherapy.

Your risk of developing AML increases with age. The median age for a person diagnosed with AML is about 68, and the condition is rarely seen in children.

AML is also more common in men than women, although it affects boys and girls at equal rates.

Cigarette smoking is thought to increase your risk of developing AML. If you work in an industry where you may have been exposed to chemicals such as benzene, you’re also at higher risk.

Your risk also goes up if you have a blood disorder such as myelodysplastic syndromes (MDS) or a genetic disorder such as Down syndrome.

These risk factors don’t mean you’ll necessarily develop AML. At the same time, it’s possible for you to develop AML without having any of these risk factors.

The World Health Organization (WHO) classification system includes these different AML groups:

  • AML with recurrent genetic abnormalities, such as chromosomal changes
  • AML with myelodysplasia-related changes
  • therapy-related myeloid neoplasms, which may be caused by radiation or chemotherapy
  • AML, not otherwise specified
  • myeloid sarcoma
  • myeloid proliferations of Down syndrome
  • acute leukemia of ambiguous lineage

Subtypes of AML also exist within these groups. The names of these subtypes may indicate the chromosomal change or genetic mutation that caused the AML.

One such example is AML with t(8;21), where a change occurs between chromosomes 8 and 21.

Unlike most other cancers, AML isn’t divided into traditional cancer stages.

Your doctor will perform a physical exam and check for swelling of your liver, lymph nodes, and spleen. Your doctor may also order blood tests to check for anemia and to determine your WBC levels.

While a blood test may help your doctor determine whether there’s a problem, a bone marrow test or biopsy is needed to diagnose AML definitively.

A sample of bone marrow is taken by inserting a long needle into your hip bone. Sometimes the breastbone is the site of biopsy. The sample is sent to a lab for testing.

Your doctor may also do a spinal tap, or lumbar puncture, which involves withdrawing fluid from your spine with a small needle. The fluid is checked for the presence of leukemia cells.

Treatment for AML involves two phases:

Remission induction therapy

Remission induction therapy uses chemotherapy to kill the existing leukemia cells in your body.

Most people stay in the hospital during treatment because chemotherapy also kills healthy cells, raising your risk for infection and abnormal bleeding.

In a rare form of AML called acute promyelocytic leukemia (APL), anticancer drugs such as arsenic trioxide or all-trans retinoic acid may be used to target specific mutations in leukemia cells. These drugs kill the leukemia cells and stop the unhealthy cells from dividing.

Consolidation therapy

Consolidation therapy, which is also known as post-remission therapy, is crucial for keeping AML in remission and preventing a relapse. The goal of consolidation therapy is to destroy any remaining leukemia cells.

You may require a stem cell transplant for consolidation therapy. Stem cells are often used to help your body generate new and healthy bone marrow cells.

The stem cells may come from a donor. If you’ve previously had leukemia that’s gone into remission, your doctor may have removed and stored some of your own stem cells for a future transplant, known as an autologous stem cell transplant.

Getting stem cells from a donor has more risks than getting a transplant made up of your own stem cells. A transplant of your own stem cells, however, involves a higher risk for relapse because some old leukemia cells may be present in the sample retrieved from your body.

When it comes to most types of AML, around two-thirds of people are able to achieve remission, according to the American Cancer Society (ACS).

The remission rate rises to nearly 90 percent for people with APL. Remission will depend on a variety of factors, such as a person’s age.

The five-year survival rate for Americans with AML is 27.4 percent. The five-year survival rate for children with AML is between 60 and 70 percent.

With early-phase detection and prompt treatment, remission is highly likely in most people. Once all signs and symptoms of AML have disappeared, you’re considered to be in remission. If you’re in remission for more than five years, you’re considered cured of AML.

If you find that you have symptoms of AML, schedule an appointment with your doctor to discuss them. You should also seek immediate medical attention if you have any signs of infection or a persistent fever.

If you work around hazardous chemicals or radiation, make sure to wear any and all available protective gear to limit your exposure.

Always see a doctor if you have any symptoms you’re concerned about.