Hundreds of thousands of Americans have been diagnosed with leukemia, one of the most common blood cancers. Although leukemia usually occurs in adults over 55 years old, it also is the most common cancer in children under 15.
There are several different types of leukemia. The type depends on the area affected and whether the cancer isfast-growing (acute) or slow-growing (chronic).
One common type of leukemia is acute myeloid leukemia (AML).
What Is Acute Myeloid Leukemia?
Acute myeloid leukemia is the most common type of acute leukemia. AML causes about 20,000 new cases and about 11,400 deaths in the United States. each year, according to the American Cancer Society. It is most common in older adults; nearly 60% of cases are in people ages 65 and older.
AML typically begins in the bone marrow, the part of your body that makes red blood cells, white blood cells, and platelets.
Most commonly with AML, your bone marrow creates an immature white blood cell called a myeloblast. Instead of maturing into a healthy white blood cell, mutations in the DNA cause the myeloblast to become leukemia cells. These leukemia cells grow and divide rapidly and can crowd out healthy blood cells.
The leukemia cells also can spread to other parts of your body, including your brain, spinal cord, skin, and gums.
While AML typically begins with abnormal white blood cells, abnormal red blood cells or platelets also can cause the disease.
Acute Myeloid Leukemia Risk Factors
There is no specific cause of AML. However, a number of factors can increase your risk:
- Older age.
- Male gender.
- Long-term exposure to dangerous chemicals such as benzene.
- Previous treatment for cancer.
- Exposure to high doses of radiation.
- History of other blood disorders.
- Certain genetic conditions.
- Family history.
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Acute Myeloid Leukemia Symptoms
Because AML is a fast-growing type of leukemia, symptoms are common and often easier to recognize. The routine symptoms of AML include:
- Fatigue, or lack of energy.
- Shortness of breath.
- Easy bleeding or bruising.
- Weight loss, or lack of appetite.
- Bone pain.
- Joint pain.
- Night sweats.
If AML has spread to other parts of your body, it may cause other symptoms. For example, if the AML spreads to your skin, you may have lumps or spots that look like common rashes. If it spreads to your gums, you may experience pain, swelling, or bleeding in the gums.
AML also can affect your blood cell counts, which can cause symptoms.
How Is Acute Myeloid Leukemia Diagnosed?
Doctors use several different methods to diagnose AML.
A visit may begin with a physical exam and medical history. Depending on your specific symptoms, your doctor can order more tests or refer you to a specialist.
Tests that can help diagnose AML include:
- Blood tests, including a complete blood count (CBC) and blood smear.
- Bone marrow tests, including a bone marrow aspiration and bone marrow biopsy.
- Genetic tests to search for genetic markers of AML.
- Lumbar puncture to determine if the AML has spread to the spinal cord.
- Imaging tests, including x-ray, CT scan, MRI scan, and/or ultrasound.
Treatment for Acute Myeloid Leukemia
Because of how aggressive AML is, treatment usually begins quickly after diagnosis.
There are two main phases of AML treatment: remission induction therapy, which attempts to kill the leukemia cells in your blood and bone marrow and get you into remission, and remission continuation therapy, which attempts to kill any remaining leukemia cells to prevent the cancer from returning.
The treatment options for AML vary by patient. Your specific treatment plan depends on factors like your age and overall health, the subtype of AML you have, and whether the cancer has spread to other parts of your body. Your medical history — including whether you’ve received chemotherapy in the past and if you’ve had other blood cancers — also could play a role in your treatment.
There are several different types of AML treatment.
The most common treatment for AML is chemotherapy.
In chemotherapy, you receive anti-cancer drugs that attempt to kill or control the cancer cells in your body. Typically, the drugs are delivered intravenously (by IV) or orally in pill form. If your cancer has spread to other parts of your body, doctors may deliver the chemotherapy directly to those areas.
Chemotherapy can be used for both induction and continuation therapy. In continuation therapy, you receive the chemotherapy drugs in cycles — a treatment period, followed by a rest period to help your body recover from the treatment.
This treatment uses high-energy x-rays to kill cancer cells or keep them from growing. The treatment is delivered externally; a machine outside your body delivers radiation to the area of your body with cancer.
Radiation therapy is not a typical treatment for AML, but doctors can use it in some situations.
Targeted therapy uses drugs or other therapies to target specific cancer cells. One type of targeted therapy involves the use of monoclonal antibodies, which are lab-created proteins that mimic your body’s naturally occurring antibodies, which typically fight disease.
Because targeted therapy is aimed at specific cells, it is usually less harmful to healthy cells than chemotherapy and radiation.
For one specific subtype of AML known as acute promyelocytic leukemia (APL), doctors can use drugs that kill leukemia cells or help them mature into normal white blood cells.
Stem cell transplant
For some patients, a stem cell transplant can help provide a cure.
As part of this treatment, you receive intense chemotherapy and/or radiation to wipe out any remaining leukemia cells in your body. This intense treatment also kills the healthy stem cells in your bone marrow. After that, you receive an infusion of new, healthy stem cells to rebuild your immune system.
There are two types of stem cell transplants:
- Allogeneic transplant: In this type of transplant, you receive stem cells from a matched donor (typically a close relative).
- Autologous transplant: For this treatment, doctors remove stem cells from you before chemotherapy and/or radiation. These stem cells are kept frozen while you receive chemotherapy and/or radiation; they then re-infuse them when chemotherapy and/or radiation is complete.
The chemotherapy and radiation used before the stem cell transplant is so intense that not all patients are candidates for this treatment. The treatment also carries potential risks, such as graft-versus-host disease.
Factors that could determine whether you are a candidate for a stem cell transplant include your age and overall health, and whether chemotherapy alone is capable of curing your leukemia.
Can Acute Myeloid Leukemia Be Cured?
AML outcomes have improved significantly over the years with more knowledge of the disease and better treatments.
Outcomes depend on multiple factors, including your age and health, your subtype of AML, and whether the leukemia has spread.
AML usually goes into remission after the first phase of treatment. It is possible for AML to come back later return. That can lead to further treatment and possibly a stem cell transplant.
The five-year survival rate for AML is 29.5%, according to results from the Surveillance, Epidemiology, and End Results (SEER) Program. Nearly three-quarter of AML deaths are in adults ages 65 and older. The five-year survival rate for children ages 15 and under is 70.6%.
Leukemia Treatment at UPMC
The Mario Lemieux Center for Blood Cancers, part of UPMC Hillman Cancer Center, provides care for all types of leukemia, including AML. From diagnosis through treatment and beyond, our team of experts provides individualized care for your case. We also offer innovative therapies and treatments, including clinical trials.
UPMC Hillman is the only comprehensive cancer center in western Pennsylvania as designated by the National Cancer Institute.
To request an appointment, call the Mario Lemieux Center for Blood Cancers at 412-864-6600.
American Cancer Society, Acute Myeloid Leukemia (AML) in Adults. Link
Leukemia and Lymphoma Society, Acute Myeloid Leukemia. Link
National Cancer Institute, Acute Myeloid Leukemia Treatment (PDQ®) – Patient Version. Link
National Cancer Institute, Surveillance, Epidemiology, and End Results Program, Cancer Stat Facts: Leukemia — Acute Myeloid Leukemia (AML). Link
U.S. National Library of Medicine, Acute Myeloid Leukemia. Link
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