What Is Acute Myeloid Leukemia (AML)?

What Causes Acute Myeloid Leukemia?

AML occurs due to changes in the genetic material (DNA) in bone marrow cells. Doctors don’t yet know the exact causes of these genetic changes. However, certain risk factors are associated with AML, including:

• Sex: Males have a higher risk of AML than women.
• Age: In adults, the risk of AML increases with age.
• Family history: While most cases of AML are not thought to have a strong genetic link, having a close relative (especially a parent, brother or sister) may increase a person’s risk of getting AML.
• Chemical exposure: Contact with certain chemicals is linked with some types of leukemia. For example, exposure to benzene may raise person’s risk for getting AML.
• Radiation exposure: Exposure to high doses of radiation increases a person risk for AML and other leukemias.
• Chemotherapy for cancer treatment: People who get chemotherapy for cancer treatment are at a higher risk of acquiring AML at a later time.
• Rare congenital diseases: Having certain genetic disorders at birth, such as Fanconi anemia, Bloom syndrome and Ataxia-telangiectasia, increases a person’s risk for developing AML.
• Smoking: Cigarette smoke, which contains benzene and other known cancer-causing chemicals, is linked to higher risk of AML.

Signs and Symptoms of Acute Myeloid Leukemia

Signs and symptoms of early-stage AML may be similar to those caused by the flu and other common diseases. Common signs and symptoms of AML include:

• Lethargy and fatigue
• Fever
• Bone pain
• Shortness of breath
• Pale skin
• Easy bruising
• Unusual bleeding, such as frequent nosebleeds and bleeding from the gums
• Frequent infections

Note that other cancers and illnesses can cause the above symptoms. Make sure to tell your doctor about any symptoms you may have.

How Is Acute Myeloid Leukemia Diagnosed?

As an acute leukemia, AML can progress quickly. An accurate diagnosis and treatment plan are essential.

Procedures and tests used to diagnose AML include:

• Blood tests: A complete blood count (CBC) with differential test is used to measure the number of white blood cells, red blood cells and platelets in a blood sample. If a CBC test suggests leukemia, an AML diagnosis can sometimes be confirmed with additional blood testing, but often a bone marrow test is needed to confirm diagnosis.
• Bone marrow test (bone marrow aspiration and biopsy): During this test, a needle is used to extract a bone marrow sample from the hipbone or breastbone. Lab analysis will classify the blood cells in the marrow sample and determine if it contains leukemia cells. The test also looks for changes in leukemia cells and identifies whether those cells originated as B lymphocytes or T lymphocytes, which helps your doctor develop your treatment plan.
• Spinal fluid test: Also called a lumbar puncture test or a spinal tap, a spinal fluid test may be used to extract a sample of spinal fluid (the fluid that surrounds the brain and spinal cord) to check for the presence of cancer cells.
• Laboratory testing for AML subtype: AML is classified into a number of subtypes based on how mature the cancer cells are at the time of diagnosis and the extent to which those cells are different from normal cells. Lab analysis of an AML patient’s leukemia cells can determine the subtype, which is important because knowing the subtype can affect both a patient’s outlook and treatment. For example, acute promyelocytic leukemia (APL) is an AML subtype that is typically treated with drugs not used with other AML subtypes.
• Imaging tests: Imaging tests such as an X-ray, a computerized tomography (CT) scan or an ultrasound scan will be ordered if your doctor suspects that the cancer has spread outside of the blood and marrow to the brain and spinal cord or other parts of the body.

How Is Acute Myeloid Leukemia Treated?

Treatment for of AML is usually divided into two phases:

1. Induction Therapy: During this phase, the goal is to kill most of the leukemia cells in the blood and bone marrow and to restore production of normal blood cells.
2. Consolidation Therapy: Also called post-remission therapy and remission continuation therapy, this phase of treatment focuses on destroying any remaining leukemia cells that may not be active but could regrow and cause a relapse of the cancer.

A third phase, known as maintenance or post-consolidation therapy, is sometimes used after consolidation. During maintenance therapy, treatment is given over a longer period of time and typically at lower doses. Maintenance therapy may be recommended for some patients who are at a higher risk for relapse.

Some combination of the following treatment approaches may be used:

Acute Myeloid Leukemia Prognosis

AML is an aggressive, life-threatening cancer. However, a patient’s outcome depends on a number of factors, including the subtype of AML, the patient’s age and the result of other lab testing. Although AML is a serious illness, it is often treatable and even curable with chemotherapy with or without a bone marrow/stem cell transplant.