Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is a cancer affecting the blood. It makes up about one-quarter to one-third of all AML cases, and it is generally associated with worse outcomes than non-MRC AML.

The above information comes from a 2020 research article in Genes.

AML starts in the bone marrow, where blood cells originate, causing them to form abnormally. AML-MRC is a subtype that is more common in older individuals. It is less responsive to chemotherapy, and it has lower remission and survival rates than non-MRC types of AML.

Read more to learn about what AML-MRC is, its symptoms, how doctors diagnose it, and more.

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AML is a form of cancer affecting the bone marrow and blood.

Doctors break AML into different subtypes according to what the blood cells look like under a microscope. The subsets determine what treatment options are best, a person’s outlook, and more.

AML-MRC is a subtype that makes up about 25–34% of all AML cases.

The World Health Organization (WHO) first classified AML-MRC in 2008. It defined it as more than or equal to 20% myeloid blasts, which are immature cells in the bone marrow or blood, and one or more of the following:

Doctors use blood and bone marrow tests to diagnose AML-MRC.

Blood tests

A complete blood count (CBC) with differential determines the number of and different types of white blood cells, red blood cells, and platelets.

People with AML typically have high levels of white blood cells — these are actually the abnormal leukemia cells. They may also have low red blood cell counts and low platelet counts.

Doctors usually order a peripheral blood smear for further information about the leukemia cells in the blood. They will examine the number, shape, and size of these various blood cells under a microscope.

Bone marrow tests

A bone marrow aspiration takes a liquid bone marrow sample. A doctor usually extracts these samples from the hip bone with a long needle.

A laboratory can then examine the samples under a microscope to look for abnormalities.

Cell assessment

A specialist called a hematopathologist may examine the blood and bone marrow samples.

They may use a method called flow cytometry to diagnose AML. To do this, they examine leukemia cells under a microscope and look for specific antigens on their surface.

Normal cells have a pattern of antigens that shows the cell’s lineage, which is how advanced it is in the process of changing from one cell type to another. Flow cytometry can identify abnormalities that may indicate AML.

Because the signs and symptoms of AML can mimic those of common illnesses, such as the flu, people should contact a doctor if symptoms persist.

AML-MRC may have the same symptoms as general AML, including:

  • loss of appetite
  • unexplained weight loss
  • bone and joint pain
  • swollen abdomen due to enlarged spleen or liver

Symptoms of a low white blood cell count include frequent infections and fever. If a person has a low red blood cell count, they may experience:

  • tiredness
  • weakness
  • dizziness
  • headaches
  • pale complexion
  • shortness of breath during normal daily activities

Symptoms of a low platelet count include:

  • bruising
  • bleeding gums
  • nosebleeds
  • minor cuts that bleed for a long time
  • tiny red spots on the skin called petechiae

The median age of an AML-MRC diagnosis is 70.

This means individuals are likely to have pre-existing health conditions. They may be less able to cope with intensive chemotherapy treatment.

Traditionally, doctors treated AML with a chemotherapy regimen of cytarabine and anthracycline followed by an allogeneic hematopoietic stem cell transplant (alloHSCT).

A stem cell transplant involves harvesting healthy blood-forming cells from a donor. A doctor gives them to the person undergoing treatment to replace the stem cells that chemotherapy destroyed.

Because of the poor outcomes with standard chemotherapy, doctors may consider therapies that may be more effective for older individuals, including:

  • liposomal daunorubicin–cytarabine (CPX-351), a combination of two chemotherapy drugs
  • venetoclax, a medication doctors use to treat chronic lymphocytic leukemia, small lymphocytic lymphoma, and AML in people aged 75 or older or who cannot receive chemotherapy
  • decitabine and azacitidine — chemotherapy drugs that doctors use to treat myelodysplastic syndrome

People with AML-MRC often do not enter remission, and the median overall survival rate is 9–12 months.

However, as medicine advances, more successful treatments could become available to people living with AML-MRC. This may improve their outcomes.

Cancer can be an isolating experience, and individuals receiving an AML-MRC diagnosis will likely feel a range of emotions. They may be confused, scared, and worried, but support can help their mental health and overall well-being.

Cancer does not have to be a lonely disease — numerous websites and other resources can connect individuals with others having the same experience.

The American Cancer Society provides various support services, including:

  • education services
  • trained cancer information specialists
  • 24/7 cancer helpline
  • accommodation and transportation to treatments
  • Cancer Survivors Network

Additionally, Cancer Care provides counseling, financial assistance, and community programs for people affected by leukemia.

Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is a subtype of acute myeloid leukemia (AML). It is typically diagnosed in people in their 70s and makes up 25–34% of AML diagnoses.

It is challenging to treat and is associated with worse outcomes than other types of AML.