Leukemia (AML)

Overview »

Overview

What causes this rare blood cancer, and how do doctors treat it? SurvivorNet's team of experts demystifies acute myeloid leukemia (AML), and helps you navigate every step of the treatment process.

Acute Myeloid Leukemia (AML) Overview

Acute myeloid leukemia (AML) is a cancer that affects bone marrow, the spongy tissue inside of your bones. It’s a rare cancer overall, but it is the most common type of leukemia in adults. Rarely, children also get AML.

To understand acute myeloid leukemia (AML), you have to know how bone marrow works, explains Dr. Mikkael Sekeres, director of the Cleveland Clinic Cancer Center Leukemia Program 

This disease is caused by DNA damage to the cells in your bone marrow that give rise to blood cells. Red blood cells carry oxygen to tissues, white blood cells fight infections as part of the immune system, and platelets help stop bleeding. Those cells are damaged in AML, and the damage results in an overproduction of unnecessary white blood cells.

 

What Increases Your Risk for AML?

SurvivorNet’s experts say doctors don’t know exactly what causes cells to turn cancerous in AML. It’s likely there is no one cause. However, there are environmental risks that, along with genetic changes, might cause cells to change into leukemia.

A risk factor is something that can increase the likelihood of you developing a disease. Just because you have a risk factor doesn’t mean that you will get the disease, and not having the risk factor doesn’t mean that you will definitely not get it. Some risk factors can be changed (for example, smoking) and others can’t be changed (such as your age or a genetic mutation).

Could you be at risk for AML? Dr. Gail Roboz of Weill Cornell Medicine overviews the factors that could slightly increase your risk for this cancer.

You might be at higher risk for AML if you:

  • Are age 65 or older. The risk rises as you age.
  • Are male. Men are more likely to get AML than women.
  • Have been treated for cancer in the past. If you’ve had certain chemotherapy or radiation treatments, they might increase your risk of getting AML.
  • Have had certain exposures. Radiation or chemicals like benzene and formaldehyde might increase your risk.
  • Smoke, or smoked in the past. Cigarette smoking has been linked to AML.
  • Had another blood disorder. Myelodysplasia or myelofibrosis could put you at greater risk.
  • Have certain genetic disorders. Down syndrome and other genetic syndromes affect AML risk.

Remember that AML is rare overall. So even if you have any of these factors, your likelihood of getting this cancer is very low.

Some preventive measures you can take to reduce your risk of developing AML are:

  • Not smoking, or quitting if you already smoke. Smoking is the biggest controllable risk factor for AML.
  • Avoiding exposure to cancer-causing chemicals like benzene.

Chemotherapy and radiation treatment for other cancers could increase your risk of getting AML, but doctors haven’t yet found a way to circumvent this issue.

Do I Need Screening?

AML doesn’t have the equivalent of a routine mammogram or pap smear. You can’t do self-exams, like for breast cancer. You could notice symptoms first, or your doctor might find AML incidentally on a blood test that you have for another reason.

 

What Are the Symptoms of AML?

AML causes certain symptoms, but having these symptoms doesn’t necessarily mean that you have AML. Your doctor will do diagnostic tests to confirm whether or not you have AML before recommending a treatment.

The symptoms of AML can be subtle, says Dr. Mikkael Sekeres

AML symptoms include:

  • Fever
  • Frequent infections
  • Feeling tired or weak
  • Easy bruising or bleeding
  • Petechiae, which are blood spots under the skin
  • Weight loss or loss of appetite
  • Dull or sharp bone pain, usually in the legs and arms
  • Pale skin

Getting a Diagnosis

The tests your doctor can use to diagnose you with AML 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 sample of the bone marrow helps to 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.

Dr. Tara Lin describes what happens during a bone marrow biopsy 

After a diagnosis, it’s important for your doctor to know your risk group, which is based on your gene mutations and chromosomes. This will help your doctor find the right therapy for you.

AML Treatment Options

AML treatment is typically done in two phases:

Induction chemotherapy uses strong drugs to reduce the number of leukemia cells in your body and put you into remission.

How do you and your doctor make important AML treatment decisions?

The initial chemotherapy treatment includes a combination of two drugs. Sometimes doctors add a targeted drug, which blocks certain proteins or other substances the cancer cells need to grow.

Dr. Richard Stone of Dana-Farber Cancer Institute describes the two phases of AML treatment

Post-remission, or consolidation therapy is the next phase of treatment, which starts once you’re in remission. The goal is to get rid of any remaining cancer cells and keep you in remission.

This phase can include high-dose chemotherapy or a stem cell transplant (also called a bone marrow transplant), in which you get very high doses of  chemotherapy to kill the abnormal bone marrow cells, and then healthy cells from yourself or a donor to replace the cells that chemotherapy killed. Targeted drugs may be used for consolidation, too.

Medical oncologist, Dr. Caitlin Costello, tells you what to expect after a stem cell transplant

Other, newer treatments are being tested in clinical trials. Ask your doctor if any therapies under investigation might be appropriate for you.

The effects of leukemia treatment are very individualized. Treatment may get rid of all leukemia cells for some people, while others will have to remain on chemotherapy long-term to control their cancer. Expect to have follow-up exams after treatment, usually every month to begin with, and then at longer intervals. These repeat visits are designed to help your doctor spot the signs of a relapse, if it occurs.

What happens when AML returns? NYU Langone Health Clinical Leukemia Program director, Dr. Raoul Tibes, explains 

Many people work with their cancer care team to develop a survivorship care plan. This helps them strategize next steps, figure out ways to cope with the side effects of treatment, schedule follow-up exams, and manage their diet/exercise goals.