Acute Myelogenous Leukemia—Adult
(AML—Adult; Acute Myeloid Leukemia—Adult; Acute Myeloblastic Leukemia—Adult; Acute Granulocytic Leukemia—Adult; Acute Nonlymphoblastic Leukemia—Adult)
Acute myelogenous leukemia (AML) is a cancer of the blood and bone marrow. With AML, the bone marrow makes abnormal blood cells including:
- Myeloblasts—a type of white blood cell; white blood cells fight infection
- Red blood cells (RBCs)—carry oxygen
- Platelets—makes blood clot, stops bleeding in cuts or bruises
AML begins in immature myeloblasts and progresses very quickly. It may also be the end state of chronic myelogenous leukemia (CML).
White Blood Cells
Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.
It is not clear exactly what causes these problems in the cells, but it is probably a combination of genetics and environment.
Current or past smoking is strongly associated with AML. Risk is compounded by how much you smoked and for how long. AML is more common in men.Other factors that may increase your chance of AML include:
- Certain genetic disorders.
- Previous chemotherapy or radiation therapy treatment.
- Previous treatment for childhood acute lymphoblastic leukemia (ALL), Hodgkin’s disease, non-Hodgkin’s lymphoma, and certain other cancers.
- History of a blood disorder, such as myelodysplastic syndrome —Precancerous changes in the white cells and precursor cells of the bone marrow.
- Exposure to the chemical benzene.
- Exposure to atomic bomb radiation or a nuclear reactor accident.
AML may cause:
- Shortness of breath
- Paleness (a sign of anemia )
- Easy bruising or bleeding
- Petechiae (flat, pinpoint spots under the skin caused by bleeding)
- Loss of appetite
- Weight loss
- Bone pain
- Joint pain
- Enlarged liver and spleen
- Swelling, pain, and bleeding of the gums
- Painless lumps in the neck, underarms, stomach, or groin
Your doctor will ask about your symptoms and medical history. A physical exam will be done, paying particular attention to swelling of the liver and spleen. The doctor will also look for swelling in lymph nodes in the armpits, groin, or neck. You will likely be referred to an oncologist. This is a doctor who focuses on treating cancer.
Tests may include the following:
- Blood tests
- Your doctor may need to collect fluid samples through:
- Routine microscopic exam—examination of a sample of blood, bone marrow, lymph node tissue, or cerebrospinal fluid
- Bone, blood marrow, lymph node tissue, or cerebrospinal fluid tests—to distinguish between types of leukemia
- Cytogenetic analysis—a test to look for certain changes of the chromosomes (genetic material) of the lymphocytes
- Immunophenotyping—examination of the proteins on cell surfaces and the antibodies produced by the body; to distinguish lymphoblastic from myeloid leukemia and determine types of therapy
- Imaging tests evaluate bodily structures. These may include:
After AML is identified, it can be classified as one of 8 subtypes. These subtypes are based on the type of cell from which leukemia developed. Classification is important. It can help make a prognosis and design a treatment plan.
Talk with your doctor about the best plan for you. Treatment of AML usually involves 2 phases:
- Remission induction therapy—to kill leukemia cells
- Maintenance therapy—to kill any remaining leukemia cells that could grow and cause a relapse
Treatment options include:
Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms. This includes pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body. While this will focus on cancer cells, some healthy cells are also killed.
Some AML may spread to the brain and spinal cord. In this case, intrathecal chemotherapy may be used. Chemotherapy drugs are placed directly into the spinal column.
Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors. For AML, external radiation therapy is used.
The radiation is directed at the tumor from outside the body. This type of treatment is used for AML that has spread, or may spread, to the brain and spinal cord. It can also be used to treat bone pain that comes from bone affected by the leukemia.
Chemotherapy With Stem Cell Transplant
Chemotherapy is followed by a transplantation of stem cells (immature blood cells). These will replace blood-forming cells destroyed by cancer treatment. Stem cells are removed from the blood or bone marrow of the patient or a donor. They are then infused into the patient.
Other Drug Therapy
These drugs may be used with certain types of leukemia. They can kill leukemia cells, stop them from dividing, or help them mature into white blood cells:
- Arsenic trioxide
- All-trans retinoic acid (ATRA)
Monoclonal Antibody Therapy
This therapy uses antibodies made in a lab. The antibodies help to identify substances on cancer cells or on normal cells that may help cancer grow. The antibodies attach to these substances. This kills the cancer cells, blocking their growth, or preventing them from spreading.
Biologic therapy uses medications or substances made by the body. The substance is used to increase or restore the body's natural defenses against cancer. This type of therapy is also called biological response modifier therapy. It is still being tested in clinical trials.
Treatment of Side Effects
Treatment usually causes side effects. These may be the result of leukemia and/or therapy. These include:
- A reduction in red blood cells—anemia
- Reduced numbers of platelets that assist in blood clotting—thrombocytopenia
- Decreased numbers of the white blood cells that fight infection
Anemia may lead to fatigue. If severe, it can complicate respiratory or cardiac disease. Thrombocytopenia may lead to bleeding and bruising. People with decreased numbers of white blood cells are more vulnerable to infection.
Your doctor may prescribe a number of different treatments to decrease these side effects. Drugs are available to increase production of normal blood cells. In addition, when your counts are particularly low, blood transfusions or changes in daily activities may be needed. These steps will reduce the chance of fatigue, bleeding, or infection.
There are no current guidelines to prevent AML. Smoking is the most common risk factor. Talk to your doctor about how you can successfully quit .
American Cancer Society
The Leukemia and Lymphoma Society
BC Cancer Agency
Canadian Cancer Society
Adult acute myeloid leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/adultAML/Patient. Updated July 30, 2012. Accessed October 30, 2012.
Childhood acute myeloid leukemia/other myeloid malignancies (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/childAML/patient. Updated August 13, 2012. Accessed October 30, 2012.
Larson RA, Sievers EL, Stadtmauer EA, et al. Final report of the efficacy and safety of gemtuzumab ozogamicin (Mylotarg) in patients with CD33-positive acute myeloid leukemia in first recurrence. Cancer. 2005;104(7):1442-1452.
Leukemia–acute myeloid. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003110-pdf.pdf. Accessed October 30, 2012.
5/12/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Davis AS, Viera AJ, et al. Leukemia: an overview for primary care. Am Fam Physician. 2014;89(9):731-738.
8/26/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Fircanis S, Merriam P, et al. The relation between cigarette smoking and risk of acute myeloid leukemia: An updated meta-analysis of epidemiological studies. Am J Hematol. 2014;89(8):E125-E132.
Last reviewed December 2014 by Mohei Abouzied, MD, FACP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.