What Is Acute Myeloid Leukemia (AML)?

Leukemia is not one disease. Although it is a form of cancer affecting blood cells, there are several types. AML is the most common type in adults.

Leukemias start in cells that normally develop into blood cells, most often white blood cells. There are several types of leukemia, which are divided based mainly on whether the leukemia is acute (fast growing) or chronic (slower growing) and whether it starts in myeloid cells or lymphoid cells.

Acute myeloid leukemia (AML) starts in the bone marrow (the soft inner part of certain bones, where new blood cells are made). AML occurs when a bone marrow cell develops changes (mutations) in its genetic material (DNA). It often moves rapidly into the blood and, less often, to the lymph nodes, liver, spleen, central nervous system (brain and spinal cord), and testicles.

AML has many other names, including acute myelocytic leukemia, acute myelogenous leukemia, acute granulocytic leukemia, and acute non-lymphocytic leukemia.

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AML is the most common form of leukemia in adults. Your risk for this type of leukemia increases as you get older. If you've had therapy for other types of cancer, you may develop AML as a late side effect. 

It is a very aggressive cancer if left untreated. But if it’s treated with chemotherapy right away, doctors can cure some types of AML. People younger than 60 have a better outlook.

Symptoms of AML

Symptoms can include:

• Fever
• Bone pain
• Fatigue
• Shortness of breath
• Pale skin
• Frequent infections
• Easy bruising
• Unusual bleeding

Generally, cancers involve a main tumor, which may have spread to other parts of your body. AML does not usually form tumors but spreads throughout bone marrow.

Doctors won’t talk to AML patients about a “stage” (information about the location, size, and extent of a cancer). Instead, they’ll discuss the type of AML you have, a factor for the most appropriate treatment.

Causes of AML

It is not clear what causes the DNA mutations that lead to leukemia, but risk factors include:

• Increasing age, usually in adults over 65.
• Men are more likely than women to develop AML.
• People who have had certain types of chemotherapy or radiation therapy during cancer treatment.
• Exposure to some chemicals, such as benzene.
• Smoking cigarettes, which contain benzene and other cancer-causing chemicals.
• Some blood disorders.
• Genetic disorders, such as Down syndrome.

Diagnostic tests for AML

• Blood tests. People with AML have too many white cells and not enough red blood cells or platelets.
• Bone marrow test. A needle biopsy will check for leukemia cells. They will be taken from a hipbone and sent to a lab for testing.
• Lumbar puncture. This is called a spinal tap, in which fluid removed from around the spinal cord is check for leukemia cells.

If you are diagnosed with AML, you may have further testing to determine the subtype or extent of the cancer. A subtype is based on how cells appear under a microscope. It determines the seriousness or prognosis of your leukemia and which treatment you should receive.

Treatment of AML

• Remission induction therapy. This treatment kills most of the leukemia cells in your blood and bone marrow.
• Consolidation therapy. Also called post-remission therapy, this treatment destroys any remaining leukemia cells to lower your chances of a relapse.

Therapies during those phases of treatment include:

• Chemotherapy. This treatment uses chemicals to kill the cancer cells in your body. People with AML are hospitalized during chemotherapy because the drugs can destroy normal blood cells in addition to the cancer cells.
• Targeted therapy. These drugs focus on specific abnormalities within the cancer cells.
• Bone marrow transplant. This treatment helps re-establish healthy cells, replacing unhealthy bone marrow with leukemia-free stem cells to regenerate healthy bone marrow.

Up to half of patients who go into remission may maintain that status long-term. Others may need ongoing chemotherapy or other therapies to keep the disease from advancing and manage symptoms.

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