Understanding Acute Myeloid Leukemia
- Danika Hilmer suffered from excessive bleeding after giving birth to her third son. Shortly after, a blood test revealed she had rare acute myeloid leukemia (AML), a type of cancer that affects the blood and bone marrow.
- She’s now in remission after undergoing chemotherapy and a stem cell transplant, but was recently diagnosed with early-stage breast cancer and is preparing to undergo a double mastectomy. She hopes by sharing her story, others will be encouraged to get routine screenings.
- Acute myeloid leukemia, also known as AML, is a cancer that affects bone marrow the spongy tissue inside of your bones. It is a rare cancer overall, but it is the most common type of leukemia in adults, like Hilmer. Children rarely get AML.
- AML is diagnosed by extracting samples of liquid bone marrow and a chip of bone from the back of the hip. The samples are then tested to determine if blood cells in the bone marrow are abnormal.
- Stem-cell transplants can be effective in the treatment of blood cancers such as AML, and it’s something Hilmer underwent. However, not all people with AML are candidates for stem-cell transplants. Doctors evaluate each person’s individual risk potential to determine who is a candidate for one.
The esthetician and skin therapist, who was 32 years old at the time of her diagnosis, is now 34 and working to raise awareness for the disease, in addition to encouraging others to go for routine check ups, even if they don’t have symptoms.
Read MoreShe explained, “We’re just admiring our new baby and soaking it all in. The doctor said, ‘The labs came back from the sample that I just sent off, and it came back positive for acute leukemia.’ And I didn’t know what acute meant. All I heard was leukemia.”
Despite her pregnancy being normal and prior bloodwork not revealing anything alarming, she did recall having “intense pains” that would radiate down her body, about a month prior to giving birth.
She then admitted to thinking the pain she endured was sciatica pains, even going to the hospital to seek help, only to be told she was dealing with “pregnancy pains.”
However, on October 22, 2022, she went into labor and gave birth at the hospital, where she learned she had cancer.
She explained, “The delivery was fine. It’s obviously common to be losing blood after delivery. This went on for I want to say roughly 30 minutes to an hour of the nurses pressing on my stomach and measuring and keeping track of how much blood I was losing.
“I was hemorrhaging. I was losing so much blood.”
After a nurse gave her medication to slow down the bleeding, the medical team realized that wasn’t helping and decided to do blood work.
Hilmer recounted her doctor telling her, “Your platelet counts were dangerously low, and that is why you were losing so much blood.”
She described feeling incredibly emotional at that time, as she also found out she had Covid-19 and need to be transferred to another hospital and begin chemotherapy immediately, “within hours of giving birth.”
After undergoing chemotherapy for about a month in the hospital, she was able to return home, but she needed to undergo “multiple” blood and platelet transfusions.
She also underwent maintenance chemotherapy until she received a stem cell donor in January 2023, further explaining how her doctors “thought it was important for me to get the stem cell transplant in order to have the best chance of non-relapsing and not having the cancer come back.”
After a “successful” transplant, Hilmer is grateful her doctor chose to check her bloodwork instead of performing a hysterectomy to stop the bleeding.
“Anybody who might be worried about (excessive bleeding should) take a blood count. It’s easy enough. There could be a lot of different reasons why somebody would have abnormal bleeding that isn’t leukemia, but that test will definitely pick up leukemia if it happens,” she said.
Although Hilmer is now in remission from AML, she has since been diagnosed with stage one invasive ductal carcinoma breast cancer and will be soon undergoing a double mastectomy.
Understanding Acute Myeloid Leukemia
Acute myeloid leukemia, also known as AML, is a cancer that affects bone marrow the spongy tissue inside of your bones. It is a rare cancer overall, but it is the most common type of leukemia in adults, like Hilmer. Children rarely get AML.
“To understand acute myeloid leukemia, you have to understand how the bone marrow works,” Dr. Mikkael Sekeres, former director of the Leukemia Program at Cleveland Clinic Cancer Center and current chief of the Division of Hematology at University of Miami Health System, previously told SurvivorNet.
“The bone marrow is the factory that makes all of the cells that wind up in our blood stream.”
What is Acute Myeloid Leukemia (AML)?
This so-called factory makes red blood cells that bring oxygen to our tissues, white blood cells that make up the immune system, as well as platelets, which help stop bleeding, Dr. Sekeres explained.
All of these cells perform essential functions in the body, and a spike or decline in any of them can lead to some serious health issues.
“When a person has cancer of the bone marrow, such as acute myeloid leukemia or myelodysplastic syndromes, that factory gets broken. These are cancers,” he said. “Cancers grow, and they grow in an uncontrollable way.”
Dr. Sekeres pointed out that the way blood cancer grows is different from the way other, solid-tumor cancers grow. With breast cancer, for example, someone may develop a lump or a tumor that grows overtime. With AML, as cancer grows in a confined space (the bone marrow), the normal cells in this space that would be making the red blood cells, white blood cells and platelets, begin dying off. This leads to the bone marrow being filled with cancer cells.
How to Recognize Symptoms of Acute Myeloid Leukemia
Treating Acute Myeloid Leukemia (AML)
Acute myeloid leukemia is a fast-growing blood cancer that begins in the bone marrow, the factory that makes white and red blood cells and platelets. Within the bone marrow are stem cells that eventually develop into white blood cells (WBCs), red blood cells (RBCs), and platelets, which help blood clot.
Stem cells can copy themselves to make progenitor cells or precursor cells. Myeloid progenitor cells turn into red blood cells, granulocytes (a type of white blood cell), and platelets. AML affects the myeloid progenitor cells during a stage of development when they are called myeloblasts.
With AML, myeloblasts fail to turn into fully developed blood cells, leaving them to build up in the bone marrow and blood.
AML is diagnosed by extracting samples of liquid bone marrow and a chip of bone from the back of the hip. The samples are then tested to determine if blood cells in the bone marrow are abnormal.
WATCH: An AML Diagnosis What are the Next Steps?
Dr. Gail Roboz, an AML expert and medical oncologist at Weill Cornell Medicine, explained to SurvivorNet in an earlier interview, “The majority of patients have this sporadically out of the clear blue sky.”
Symptoms for acute myeloid leukemia can include:
- Flu-like symptoms
- Fatigue
- Fever
- Loss of appetite
AML causes certain symptoms, but having these symptoms doesn’t necessarily mean you have AML. Your doctor will do diagnostic tests to confirm whether or not you have AML before recommending a treatment.
Your doctor will then perform tests to diagnose you, and those tests include:
- Blood tests. In people with AML, white blood cell counts may be high, and red blood cell and platelet counts may be low. These tests can also show immature cells in the blood that should only be found in the bone marrow.
- Bone marrow biopsy. Removing and testing a bone marrow sample helps confirm AML after an abnormal blood test result.
- Lumbar puncture. This test uses a sample of spinal fluid to diagnose AML.
- Molecular and genetic testing. Your doctor can do tests to determine whether you have certain genes related to AML and if your cancer might respond to specialized treatments.
WATCH: Treatment decisions for AML
For people deemed healthy enough, induction therapy is the standard treatment for AML. The process involves a seven-day chemotherapy regimen, followed by several weeks of recovery. The goal of this high dose of chemo is to induce remission.
A stem cell transplant is another option for treating AML. After a high dose of chemotherapy, a stem cell transplant gives the patient healthy cells to replace the ones that chemotherapy may have killed.
After chemo and a transplant, the recovery process can be difficult because the immune system will be compromised. Finding a genetic match in a donor may also be difficult.
Why a Stem-Cell Transplant?
A stem-cell transplant doesn’t directly fight cancer cells, rather it helps your body create healthy cells after chemotherapy and other treatments have destroyed them.
The first course of treatment for AML patients is generally a combination of two chemotherapy drugs, known as “induction chemotherapy.” Its goal is to kill cancer cells, but along with killing cancer cells, chemotherapy also kills the body’s healthy cells and platelets. A stem-cell transplant is designed to help rebuild those blood cells and platelets and restore the immune system. The healthy new cells may also help prohibit recurrence of the disease.
“We don’t believe that chemotherapy, for the majority of leukemias, is sufficient in order to cure patients of their disease, forever,” Dr. Caitlin Costello, hematologist-oncologist at UC San Diego Health, told SurvivorNet in an earlier interview.
“And so a transplant is an opportunity to do that cure patients with leukemia.”
Dr. Caitlin Costello breaks down the basics about stem-cell transplants for SurvivorNet
Which AML Patients are Candidates for Stem-Cell Transplants?
Not all AML patients are candidates for a stem-cell transplant. Some need only chemotherapy, and some high-risk patients may not be able to tolerate a transplant. It all comes down to your medical team determining your risk group.
Dr. Raoul Tibes, director of the Clinical Leukemia Program at NYU Langone Health, told SurvivorNet in an earlier interview that AMLs are grouped according to what are called cytogenetics (loss or changes to the structure of chromosomes) and other molecular markers. Doctors also look for genetic mutations on top of chromosomes, which could be indicators of risk.
Dr. Raoul Tibes discusses how an individual’s AML risk group is determined with SurvivorNet.
“Based on all that information, we can group leukemias into the chromosome status, as well as mutations and genes. We take them together and then we have three or four different risk stratification groups,” he says. “That helps us decide which therapy we use.”
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
ANSWER QUESTIONS
