What Is Acute Myeloid Leukemia (AML)? Symptoms and Treatment

Almost everyone has heard the word leukemia and knows it is blood cancer. However, there are many types and varieties of leukemia. Although they have different subtypes, all originate in the bone marrow, where blood cells are produced.

What Is Acute Myeloid Leukemia (AML)?

Acute myeloid leukemia (AML) is a blood cancer beginning in the bone marrow that can quickly enter the blood and potentially spread to other organs, such as the lymph nodes, spleen and testicles.

In a person with AML, the bone marrow produces cancerous versions of platelets, red blood cells and white blood cells called myeloblasts.

The word "acute" in acute myeloid leukemia indicates that the cancer can progress rapidly. This can be very stressful for patients who may be at risk, because it makes early diagnosis even more important.

What Are the Symptoms of Acute Myeloid Leukemia?

AML symptoms can vary with the severity and stage of the disease. The range is broad, or symptoms may result solely from conditions directly caused by AML, such as anemia.

AML involves many blood cells, but these cells are cancerous and nonfunctional, reducing the number of normal blood cells. Possible consequences are anemia (too few oxygen-carrying red blood cells), thrombocytopenia (too few platelets responsible for clotting), and infections (too few functioning white blood cells that fight infection).

Patients may experience symptoms such as:

• Pale skin
• Shortness of breath
• Dizziness
• Headache
• Frequent nosebleeds and bleeding gums
• Easy and/or unexplained bruising
• Easy injury
• Fatigue
• Frequent infections
• Fever
• Unexpected weight loss
• Shortness of breath

Patients with AML may also have bone or joint pain if leukemia cells have accumulated in those bones or joints.

What Causes Acute Myeloid Leukemia? Risk Factors

Although certain risk factors have been identified, the factors directly causing AML are unclear. Having the risk factors listed below does not necessarily mean a person will develop AML.

Factors potentially increasing AML risk include:

• Older age, particularly 65 and above
• Genetic disorders, including Down syndrome
• Radiation exposure, including prior cancer treatment
• Exposure to certain chemicals
• A history of myelofibrosis, myelodysplasia, polycythemia vera or other blood disorders
• A history of smoking

Men are also more likely than women to develop AML.

How Is Acute Myeloid Leukemia Diagnosed?

Cancer screening tests for early diagnosis have not yet shown the ability to detect AML early. People with possible AML symptoms should report them to a doctor as soon as possible.

If a doctor suspects a patient may have AML, tests may be ordered. Blood tests are common because an unusual proportion of each blood cell type may indicate leukemia. If a blood test finds something suspicious, a hematology specialist will generally request a bone marrow aspiration biopsy to confirm whether AML is present. In some cases, a cerebrospinal fluid (BOS) sample may be needed. Genetic testing may be requested in leukemia patients because understanding specific mutations can help determine treatment.

How Is Acute Myeloid Leukemia Treated?

• Treatment for a patient's AML is determined by factors including age, disease severity and the genetic subtype of the leukemia.
• Chemotherapy is generally recommended to kill cancer cells in the blood and bone marrow, with the aim of killing all cancerous blood cells; this is called remission.
• Some patients may need targeted therapy. These drugs target specific genetic abnormalities of cancer cells. They can be used alone or with chemotherapy as part of an all-encompassing treatment. Even after chemotherapy destroys most cancer cells and achieves remission, more treatment is needed to kill remaining cells.
• In some cases, after chemotherapy, replacing the bone marrow that produces cancer cells with stem cells may require a bone marrow (stem cell) transplant.

Related topic: The First Targeted Drug to Receive FDA Approval for Acute Myeloid Leukemia Treatment: Midostaurin

Acute leukemia treatments generally involve 3 main stages:

• Induction therapy
• Consolidation therapy
• Maintenance therapy

Induction Therapy

The aim of this stage is to kill leukemia cells using chemotherapy to induce cancer remission. This stage of treatment lasts approximately 1 month.

The drugs most commonly used in induction therapy are:

• Vincristin
• Deksametazon
• Prednizon
• Doksorubisin
• Daunorubisin

People receiving chemotherapy remain in close contact with the hemato-oncology team because of the risk of serious infections and complications.

Consolidation Therapy

Even if treatments up to this point have induced remission, cancer cells may remain hidden in the body. Consolidation therapy is therefore necessary. This stage involves high-dose chemotherapy. The treating doctor may also recommend targeted drugs or a stem cell transplant .

Maintenance Therapy

This stage consists of successive chemotherapy treatments and may last between 6 months and 2 years.

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• Related topic: All Leukemia Types and Survival Statistics

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