|
Acute myeloid leukemia
Definition
Acute myeloid leukemia (AML) is cancer that starts inside bone marrow, the soft tissue inside bones that helps form blood cells. The cancer grows from cells that would normally turn into white blood cells.
Acute means the disease develops quickly.
For information on other types of leukemia, see:
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. This article focuses on AML in adults.
AML is more common in men than women.
Persons with this type of cancer have abnormal cells inside their bone marrow. The cells grow very quickly, and replace healthy blood cells. The bone marrow, which helps the body fight infections, eventually stops working correctly. Persons with AML are more likely to have infections and have an increased risk for 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 versa, 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
- Bleeding from the nose
- Bleeding gums
- Bruising
- Bone pain or tenderness
- Fatigue
- Fever
- Heavy menstrual periods
- Pallor
- Shortness of breath (gets worse with exercise)
- Skin rash or lesion
- Swollen gums (rare)
- Weight loss
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) shows anemia and a low number of platelets. A white blood cell count (WBC) is usually high but can be low or normal.
Bone marrow aspiration 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 to kill the cancer cells. This is called chemotherapy. Most types of AML are treated the same way, with more than one chemotherapy drug, such as daunorubicin and cytarabine.
But chemotherapy kills normal cells, too. This may cause side effects such as:
- Risk of bleeding
- Increased risk for 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 treatments for AML may include:
- Antibiotics to treat infection
- Bone marrow transplant or stem cell transplant after your first round of chemotherapy
- Red blood cell transfusions to fight anemia
- Transfusions of platelets to control bleeding
One form of AML called acute promyelocytic leukemia (APL) maybe treated with a medicine calledall-trans retinoic acid (ATRA) and arsenic trioxide.
Support Groups
See:
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 other 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.
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 FM. The acute leukemias. In Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 189.
National Comprehensive Cancer Network. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Acute myeloid leukemia. 2012. Version 1.2012.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
