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 infectionRed blood cells (RBCs)—carry oxygenPlatelets—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).
Cancer occurs when cells in the body become abnormal. They divide without control or order. Leukemia is cancer of the white blood cells and their parent cells. Leukemia cells do not function normally. They cannot do what normal blood cells do. In this case, they can not fight infections. This means that the person is more likely to become infected with viruses or bacteria. The cancerous cells also overgrow the bone marrow. This forces other normal components, like platelets out. Platelets are needed to help the blood clot. As a result, people with leukemia may bleed more easily.
White Blood Cells
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The cause of AML is unknown. However,
after age 60 doubles the risk of this condition.
These symptoms may also be caused by other, less serious health conditions. See a doctor if you have any of the following: FeverShortness of breath
Paleness (a sign of
Easy bruising or bleedingPetechiae (flat, pinpoint spots under the skin caused by bleeding)WeaknessTirednessLoss of appetiteWeight lossBone painJoint painEnlarged liver and spleenSwelling, pain, and bleeding of the gumsPainless 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 testsYour doctor may need to collect fluid samples through: Bone marrow aspirationBone marrow biopsySpinal tapRoutine microscopic exam—examination of a sample of blood, bone marrow, lymph node tissue, or cerebrospinal fluidBone, blood marrow, lymph node tissue, or cerebrospinal fluid tests—to distinguish between types of leukemiaCytogenetic analysis—a test to look for certain changes of the chromosomes (genetic material) of the lymphocytesImmunophenotyping—examination of the proteins on cell surfaces and the antibodies produced by the body; to distinguish lymphoblastic from myeloid leukemia and determine types of therapyGallium scan and bone scan—injection of a radioactive chemical into the bloodstream to detect areas of cancer or infectionYour doctor may need detailed pictures of structures inside your body. These can be made with: Chest x-rayCT scanMRI scanUltrasound
After AML is identified, it can be classified as one of eight 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 two phases:
Remission induction therapy—to kill leukemia cellsMaintenance therapy—to kill any remaining leukemia cells that could grow and cause a relapse
Treatment options include:
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.
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 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.
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 trioxideAll-trans retinoic acid (ATRA)
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.
Patients will suffer side effects from the leukemia and from 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. Decreased numbers of white blood cells can leave a patient 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.
Many people who develop AML have no risk factors. There is no way to prevent the condition in most people. However, 20% of cases are related to smoking tobacco. Not smoking is the best known way to prevent AML.
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.
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05/12/2014 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 May 1;89(9):731-8.
Last reviewed December 2013 by Mohei Abouzied, MD
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.
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