Acute Myeloid Leukemia (AML)

Acute myeloid leukemia (AML) is a type of blood cancer. It usually begins in cells that turn into white blood cells. Sometimes, though, AML can start in other types of blood-forming cells.

Although there’s no cure, there are treatments that can make a big difference

Acute myeloid leukemia starts in the bone marrow. This is the soft inner parts of bones.

With acute types of leukemia such as AML, bone marrow cells don't mature the way they're supposed to. These immature cells, often called blast cells, keep building up.

You may hear other names for acute myeloid leukemia. Doctors may call it:

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

Without treatment, AML can quickly be life-threatening. Because it's "acute," this type of leukemia can spread quickly to the blood and to other parts of the body, such as the

  • Lymph nodes
  • Liver
  • Spleen
  • Brain and spinal cord
  • Testicles

Each person is different, and how acute myeloid leukemia affects them depends on certain things, including how well the cancer responds to treatment. Your outlook is better if:

  • You are younger than 60.
  • You have a lower white blood cell count when you're diagnosed.
  • You do not have a history of blood disorders or cancers.
  • You do not have certain gene mutations or chromosome changes
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According to some studies, the change in DNA can cause normal bone marrow cells to become leukemia cells. The normal human cells grow and function based on the information contained in each cell’s chromosomes. Chromosomes are long strands of DNA in each cell.

And the different cases of acute myeloid leukemia have different chromosome changes, and some changes are more common than others. Besides, most DNA changes related to acute myeloid leukemia occur during a person’s lifetime.

There are some risk factors that could lead to acute myeloid leukemia:

  • Smoking;
  • Certain chemical exposures;
  • Certain chemotherapy drugs;
  • Radiation exposures;
  • Certain blood disorders;
  • Genetic syndromes;
  • Family history;
  • Older age;
  • Male gender;
  • Uncertain, unproven or controversial risk factors.

Acute myeloid leukemia (AML) starts in the bone marrow -- the spongy tissue inside your bones where blood cells are made. The disease prevents immature blood cells from growing into healthy blood cells. You have three main types of blood cells:

  1. White blood cells fight infections.
  2. Red blood cells carry oxygen around your body.
  3. Platelets clot your blood when you're injured.

In the early stages of AML, as your body makes fewer healthy blood cells, you might feel like you've come down with the flu or another illness. Symptoms can include:

  • Tiredness
  • Fever
  • Loss of appetite
  • Weight loss
  • Night sweats

A lot of other things can cause those symptoms, too. So you and your doctor would work together to find the cause.

Symptoms by AML Type

There are several forms of AML. Each affects a different kind of blood cell. The symptoms you have depend on the type of blood cell that's affected.

If you have fewer healthy red blood cells than normal, you'll have symptoms like these:

  • Tiredness
  • Weakness
  • Pale skin
  • Irregular heartbeat
  • Dizziness
  • Cold hands and feet
  • Shortness of breath
  • Headaches
  • Weight loss
  • Loss of appetite

If you have fewer healthy white blood cells than normal, you may get more infections than usual. These infections may take a long time to get better.

Infections can cause symptoms like these:

  • Fever
  • Weakness
  • Achy muscles
  • Fatigue
  • Diarrhea

If you have fewer platelets than usual, your blood may not clot as well as it should. You might have symptoms like these:

  • Easy bruising
  • Bleeding that can be hard to stop
  • Bleeding gums
  • Small red spots under your skin caused by bleeding
  • Nosebleeds
  • Sores that don't heal

Symptoms When AML Spreads

Leukemia cells can spread to other parts of your body and cause symptoms like these:

  • Balance problems
  • Blurred vision
  • Bone or joint pain
  • Numbness in your face
  • Seizures
  • Spots or a rash on your skin
  • Swelling in your belly
  • Swollen, bleeding gums
  • Swollen glands in your neck, groin, underarms, or above your collarbone.

A fever, shortness of breath, and unusual bruising or bleeding could be signs of acute myeloid leukemia (AML). If you have any of these symptoms, see your doctor.

Your family doctor might refer you to an oncologist or hematologist -- specialists who diagnose and treat leukemia. The doctor will do tests to find out if you have AML and which type you have. The more your doctor knows about your cancer, the greater the odds that your treatment will be successful.

Physical Exam

At your visit, your doctor will ask questions about your health. During the exam, your doctor will check your body for signs of cancer, such as bruises or spots of blood under your skin.

Tests for AML

AML affects immature blood cells called stem cells that grow into white blood cells, red blood cells, and platelets.  These blood cells are made in your bone marrow -- the spongy material inside your bones. In AML, the stem cells are abnormal and can't grow into healthy blood cells.

These tests look for immature or abnormal cells in your blood and bone marrow:

  • Blood tests
  • Bone marrow tests
  • Lumbar puncture
  • Imaging tests
  • Gene tests

Blood Tests

During a blood test, your doctor uses a needle to take a sample of blood from a vein in your arm. Doctors use different types of blood tests to diagnose AML:

Complete blood count (CBC). This test checks how many white blood cells, red blood cells, and platelets you have. With AML, you may have more white blood cells and fewer red blood cells and platelets than normal.

Peripheral blood smear. In this test, a sample of your blood is examined under a microscope. It checks the number, shape, and size of white blood cells, and looks for immature white blood cells called blasts.

Bone Marrow Test

To confirm that you have AML, you'll also need a bone marrow test. The doctor will place a needle into a bone -- usually near your hip -- and remove a little bit of fluid or a small piece of bone.

The sample will go to a lab for testing. A doctor called a pathologist will look at your cells under a microscope. If 20% or more of the blood cells in your bone marrow are immature, you may be diagnosed with AML.

Lumbar Puncture (Spinal Tap)

This test uses a needle to remove a small sample of cerebrospinal fluid (CSF), the fluid that surrounds your brain and spinal cord. The CSF is examined under a microscope to see if it contains leukemia cells.

Imaging Tests

Imaging tests use radiation, sound waves, and magnets to make pictures inside your body. AML doesn't form tumors that show up on scans, but your doctor might use these tests to look for an infection or another problem AML can cause.

These imaging tests can help your doctor diagnose AML:

CT, or computed tomography. This powerful X-ray makes detailed pictures inside your body. A CT scan can show whether AML has enlarged your spleen or lymph nodes. You might get a special dye by mouth or into a vein before the test. This dye helps your doctor see your organs more clearly on the scan.

Ultrasound. It uses sound waves to see whether your lymph nodes, liver, spleen, and kidneys are enlarged.

X-ray. It uses radiation in low doses to make images of structures inside your body. Your doctor might take X-rays to see if you have a lung infection.

Gene Tests

There are several forms of AML. Your doctor can find out which one you have by looking for gene changes in a sample of your blood or bone marrow. This can help your doctor find the treatment that is most likely to work on your cancer.

These tests include:

Cytogenetic analysis looks for chromosome changes in your cells. Chromosomes are stretches of DNA. Sometimes in AML, two chromosomes switch DNA. This is called a translocation.

Immunophenotyping tests look for substances called markers on the surface of leukemia cells. Different types of AML cells have their own unique markers.

Fluorescent in situ hybridization (FISH) looks for abnormal chromosomes in your cells using special dyes that attach to certain parts of the chromosome.

Polymerase chain reaction (PCR) uses chemicals to find changes in genes.

Acute myeloid leukemia (AML) pushes your bone marrow to make large numbers of abnormal blood cells. These cells crowd out healthy red blood cells, white blood cells, and platelets. AML treatments destroy unhealthy blood cells in your bone marrow and blood. The goal is to put you into remission, which means you have no symptoms of cancer.

Several different treatments work on AML:

  • Chemotherapy
  • Stem cell transplant
  • Radiation
  • Targeted therapy

Your treatment will have two phases:

Phase 1: Remission induction therapy. You'll get high doses of chemotherapy to destroy as many leukemia cells as possible. You may need to stay in the hospital for 3 to 5 weeks so your doctor can see how you’re doing and treat you for any side effects of chemotherapy. There are targeted therapy drugs as well.

After treatment, your bone marrow should start to make healthy blood cells. Your doctor will take a bone marrow sample to see if any leukemia cells are left in your blood. If no leukemia cells are visible, doctors call that being “in remission.” You'll still need to go through post-remission therapy to help you stay in remission.

Phase 2: Post-remission therapy. Post-remission therapy uses more treatments to wipe out any cancer cells that might have been left behind after chemotherapy. You have three options:

  • Chemotherapy. You may get several cycles of high-dose chemotherapy once a month.
  • Allogenic (from a donor) stem cell transplant
  • Autologous (from yourself) stem cell transplant

Chemotherapy

Chemotherapy uses strong drugs to kill cancer cells all over your body. You get these drugs by mouth, through an IV, or via an injection under your skin.

If the cancer has spread, you'll get chemotherapy into the fluid around your brain and spinal cord. Doctors call this intrathecal chemotherapy.

Side effects: Chemotherapy works by killing quickly dividing cells in your body. Cancer cells divide quickly, but so do other cells -- like those in your immune system, the lining of your mouth and intestines, and your hair follicles. When chemotherapy damages these healthy cells, you can have side effects like these:

  • Nausea and vomiting
  • Hair loss
  • Mouth sores
  • Fatigue
  • Loss of appetite
  • Diarrhea and constipation
  • Easy bruising and bleeding
  • Increased risk for infections

Most of these side effects should go away once your treatment ends. Your doctor can give you medicines and other treatments to help you manage chemotherapy side effects.

Stem Cell Transplant

The higher the dose of chemotherapy you get, the more cancer cells it will kill. Yet high-dose chemotherapy can also damage your bone marrow and cause a dangerous drop in your blood cell levels.

Your doctor can do a stem cell transplant after chemotherapy to replace your damaged bone marrow with young stem cells from your own body or from a donor. These stem cells will grow into new, healthy blood cells.

There are two types of stem cell transplant:

An allogenic stem cell transplant uses stem cells taken from a donor. This is the most common type of stem cell transplant. A close relative like a parent, brother, or sister will be the best match. One risk of an allogenic transplant is graft-versus-host disease. The donor's cells recognize your body as foreign and attack your organs and tissues.  Symptoms include rashes, itching, nausea, diarrhea, mouth sores, and jaundice -- yellowing of the eyes and skin.

An autologous stem cell transplant removes cells from your own bone marrow or blood before you have chemotherapy. Those cells are frozen and then put back into your blood after your treatment. Because the stem cells come from your body, there's less risk of rejection. The downside is that it's hard to separate healthy stem cells from leukemia cells. You might get some leukemia cells put back in during the transplant.

After a stem cell transplant, you'll have to stay in the hospital for a while to be watched and treated for side effects. Because this treatment uses very high doses of chemotherapy, it can cause serious complications like these:

  • Higher risk of infection and bleeding from low blood cell counts
  • Damage to the lungs, bones, and thyroid gland
  • Cataracts -- clouding of the clear outer cover of the eye
  • Loss of fertility
  • Another cancer years later

Acute Promyelocytic Leukemia Treatment

Acute promyelocytic leukemia (APL) is a subtype of AML that doctors treat a little differently. In APL, the leukemia cells contain special proteins that change the way your blood clots. Chemotherapy damages the leukemia cells and releases this protein, which can cause dangerous blood clots or severe bleeding.

If you have APL, you'll get medicine to make your leukemia cells change into mature, healthy blood cells so they don't burst open and release their protein. The two drugs used to treat APL are:

All-trans retinoic acid (ATRA). You might need to stay on this drug for a year or two. Side effects include a headache, fever, rash, mouth or throat sores, itching, and high cholesterol.

Arsenic trioxide (Trisenox). Side effects include tiredness, nausea, vomiting, diarrhea, belly pain, heart rhythm problems, and nerve damage.

You might also get chemotherapy with these drugs.

Radiation

Radiation uses high-energy X-rays to destroy cancer cells. You might get radiation to treat AML that has spread to your brain and spinal cord, or to your bone. Radiation is sometimes also used before a stem cell transplant. Usually adult AML is treated with external radiation therapy, which is given from outside of your body.

Side effects from radiation include:

  • Sunburn-like redness of the skin
  • Mouth sores -- if you get radiation to your head or neck
  • Nausea, vomiting, or diarrhea -- if you get radiation to your belly
  • Fatigue
  • Bleeding or bruising
  • Increased risk of infection

Clinical Trials

If AML treatments don't work for you, or if they stop working and your cancer begins to grow again, you have another option: You can try a clinical trial.

Clinical trials are studies in which researchers test new treatments. They often are a way for you to try a new medicine that isn't available to everyone. Your doctor can tell you if one of these trials might be a good fit for you, how to sign up, and what to consider first.

It’s not clear what causes most cases of acute myeloid leukemia (AML). Since most people with AML don’t have risk factors that can be changed, at the present time there is no known way to prevent most cases of AML.

Smoking is by far the most significant controllable risk factor for AML, and quitting offers the greatest chance to reduce a person’s risk of AML. Non-smokers are also much less likely than smokers to develop many other cancers, as well as heart disease, stroke, and some other diseases.

Treating some other cancers with chemotherapy or radiation may cause secondary (treatment-related) leukemias in some people. Doctors are trying to figure out how to treat these cancers without raising the risk of secondary leukemia. But for now, the obvious benefits of treating life-threatening cancers with chemotherapy and radiation must be balanced against the small chance of getting leukemia years later.

Avoiding known cancer-causing chemicals, such as benzene, might lower the risk of getting AML. But most experts agree that exposure to workplace and environmental chemicals seems to account for only a small portion of leukemias.

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