Acute myeloid leukemia: What you need to know
In 2019, the National Cancer Institute expect that about 21,450 people will receive a new diagnosis of AML in the United States. They also predict that 10,920 people will die from the disease.
AML can develop at any age, but it is uncommon in people younger than 45 years. The average age at diagnosis is 68 years.
There are different types of AML, and some are more aggressive than others.
What is AML?
Some forms of AML are more aggressive than others.
Cancer develops when certain cells in the body reproduce without the usual controlling factors.
AML involves the body producing too many nonfunctioning, immature white blood cells. These are called blasts. They crowd out the useful cells, leading to a range of symptoms and complications.
Acute leukemia develops suddenly, while chronic leukemia lasts for a long time and progresses gradually. In a person with acute leukemia, the blasts crowd out healthy cells more quickly than in a person with chronic leukemia.
In a healthy person, blasts make up 5% or less of bone marrow, and there are no blasts in the blood. Usually, for a doctor to diagnose AML, the person's blood or marrow needs to contain at least 20% blasts.
Signs and symptoms generally develop gradually and become more severe as the blast cells take up more space in the blood.
Find out more about leukemia survival rates,
The general symptoms of AML can be similar to those of the flu.
Other symptoms, such as bruising and bleeding, result from complications that stem from changes in blood cell counts.
AML symptoms can include:
- sweating more than usual
- skin that bruises easily
- a fever
- swollen lymph nodes (glands)
- more frequent infections than usual
- pain in the joints and possibly the bones
- unexplained regular bleeding, perhaps of the nose or gums
- small red spots under the skin due to bleeding
- loss of appetite and weight loss
- abdominal pain, due to swelling in the liver, spleen, or both
- slurred speech
As AML spreads to other organs, a wide range of symptoms can develop. If the blast cells enter the central nervous system, for example, the person may experience headaches, blurred vision, dizziness, seizures, and vomiting.
AML is a fast-growing cancer. Anyone who notices unusual symptoms should see a doctor without delay. The sooner a person starts treatment, the better the likelihood that it will be effective.
Causes and risk factors
Doctors do not know what causes healthy bone marrow cells to become leukemia cells. However, there is evidence that exposure to certain environmental toxins can increase the risk.
Exposure to radiation
If a nuclear accident exposes people to radiation, they have a higher risk of developing AML.
Rarely, people who have had radiation therapy for cancer go on to develop leukemia. In this case, the leukemia is a secondary cancer.
Other sources of radiation can be harmful. A study published in The Lancet in 1999 found that pilots with over 5,000 hours of flight time may be exposed to enough radiation to increase their risk of AML.
This is because flying takes a person closer to the sun.
People who work around benzene should protect themselves from fumes.
Exposure to benzene may increase the risk of health conditions that can become cancerous at a later stage.
Benzene is a component of crude oil and gasoline. It is also present in household glues, cleaning products, tobacco smoke, gasoline, and paint stripping products, among others.
People who work in the production of plastics, synthetic fibers, rubber lubricants, drugs, pesticides, and many other products may have an increased risk of exposure to benzene.
Overall, take care to avoid:
- breathing in gasoline and solvent fumes
- getting benzene-related products on the skin
- spilling benzene-related products on the ground
People who smoke appear to have a higher risk of AML. This may be because benzene is present in cigarette smoke.
Smoking can affect the body in many ways. Learn more here.
Health and genetic factors
People with certain health conditions may have a higher risk of developing AML.
These conditions include:
Some kinds of chemotherapy can also increase the risk.
If a person notices symptoms that could indicate AML, they should see a doctor.
The doctor will:
- ask about symptoms
- ask about personal and family medical histories
- perform a physical examination
If leukemia could be present, they will recommend blood and bone marrow tests.
Bone marrow testing
There are two ways to collect bone marrow samples:
Aspiration involves using a needle to extract some bone marrow fluid.
A biopsy involves using a larger needle to remove a small piece of bone and marrow.
If symptoms indicate that AML has reached the brain, the doctor may use a lumbar puncture to extract some spinal fluid for testing.
Blood tests can show:
- what type of leukemia is present
- the proportion of blast cells in the body
- which organs it affects
A doctor will diagnose AML if tests show that either:
- 20% or more of the bone marrow or blood consists of blasts
- there are genetic features that only occur in people with AML
Treatment options for AML include:
- targeted therapy
- radiation therapy
- stem cell therapy, also known as bone marrow transplantation
Treatment aims to reduce the blast count in bone marrow to below 5%.
Chemotherapy is the main treatment. It involves using powerful drugs to kill cancer cells throughout the body. However, it can cause severe adverse effects.
Stem cell therapy, or bone marrow transplantation, can help the body recover after high doses of chemotherapy. The doctor may recommend this to help a person tolerate a higher dosage of chemotherapy.
Targeted therapy involves drugs that target specific substances, often proteins, that play a role in promoting cancer growth. Blocking these proteins can help prevent or delay the growth. A doctor may recommend this treatment instead of chemotherapy or alongside it.
Radiation therapy may help some people with AML. It can help reduce bone pain, for example, if chemotherapy has not been effective.
When blast levels have fallen below 5%, the cancer is in remission. In around two-thirds of people who have induction chemotherapy for AML, it will go into remission. "Induction chemotherapy" is the term for chemotherapy that aims to induce remission.
Whether treatment will lead to remission depends on various factors, including the type of AML and the person's age and overall health.
AML will go into long-term, and possibly lifelong, remission in up to 50% of people who have the disease.
Here, learn more about chemotherapy.
AML does not always go away completely. When it comes back after being in remission, this is called a recurrence.
A recurrence is most likely while the person is receiving treatment or shortly after they have completed a course of chemotherapy. AML does not usually recur after it has been in remission for several years.
Anyone who has had leukemia will continue to visit their doctor for tests.
The doctor will monitor for any:
- signs of recurrence
- adverse effects that persist after treatment
Following treatment with chemotherapy, a person may have a severely weakened immune system. This leads to a high risk of infections, and the doctor may prescribe antibiotics to treat any infections that develop.
In some people, AML goes away completely after treatment. Others may live for many years with chronic — or long term — AML.
Anyone who has AML should attend all scheduled appointments, including tests and treatment sessions.
The following lifestyle choices may also help:
- having a healthful diet
- exercising, when possible
- getting enough rest
- avoiding smoking
The American Cancer Society report that there is no evidence that any dietary supplement can help reduce the risk of a recurrence.
Speak to the doctor before making any lifestyle or dietary changes, as some changes may not be healthful for a person with AML.
A person can speak to their doctor about the various treatments for AML.
AML can be life threatening, but treatment can often achieve remission, which may be permanent.
Past statistics suggest that, on average, people who are at least 20 years old when they receive an AML diagnosis have roughly a 24% chance of surviving for another 5 years or longer.
For those younger than 20, around 67% will likely live for at least another 5 years.
However, this depends on many factors, including the person's age, overall health, and access to treatment.
Treatment can take a long time, and it can be costly. People who have health insurance should check whether their policy covers cancer treatment. If it does, it should cover treatment for leukemia, including AML.
Various other organizations can also help cover the cost of treatment and related needs, such as home care.
Doctors do not know why AML develops, so it is not possible to prevent it.
However, doing the following can reduce the risk:
- minimizing exposure to radiation, when possible
- taking precautions when dealing with benzene and related products
- avoiding smoking
People with jobs that increase their risk of radiation or benzene exposure should ensure that they follow health and safety guidelines.
If a person has complete remission after AML, can they go on to have an active lifestyle, or will they always have problems, for example, with their immune system?
f you are in complete remission after AML, you can live a regular, active life. Usually, people follow up with their cancer doctor monthly for the first few years after going into remission to make sure that there is no recurrence.
If you still stay in remission after a few years, you will need to follow up less frequently, but at least once per year. You will not have problems with your immune system unless you have a recurrence of AML.
Also, some people develop side effects of chemotherapy. Some side effects go away, but others can be long lasting. You should discuss your side effects with your cancer doctor.Alana Biggers, MD, MPH Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.