Acute myelogenous leukemia

Acute myelogenous leukemia (AML) is a cancer of the blood and bone marrow — the spongy tissue inside bones where blood cells are made.

The word “acute” in acute myelogenous leukemia denotes the disease’s rapid progression and the fact that it affects immature blood cells, rather than mature ones. It’s called myelogenous (MI-uh-loj-uh-nus) leukemia because it affects a group of white blood cells called the myeloid cells, which normally develop into the various types of mature blood cells, such as red blood cells, white blood cells and platelets.

Acute myelogenous leukemia is also known as acute myeloid leukemia, acute myeloblastic leukemia, acute granulocytic leukemia and acute nonlymphocytic leukemia.

General signs and symptoms of the early stages of acute myelogenous leukemia may mimic those of the flu or other common diseases. Signs and symptoms may vary based on the type of blood cell affected. Signs and symptoms of acute myelogenous leukemia include:

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

When to see a doctor
Make an appointment with a doctor if you develop any signs or symptoms that seem unusual or that worry you. Acute myelogenous leukemia worsens quickly if not treated, so a prompt diagnosis is helpful.

Acute myelogenous leukemia is caused by damage to the DNA of developing cells in your bone marrow. When this happens, blood cell production goes awry. The bone marrow produces immature cells that develop into leukemic white blood cells called myeloblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells.

It’s not clear what causes the DNA mutations that lead to leukemia. Radiation, exposure to certain chemicals and some chemotherapy drugs may play a role. It’s believed that most cases of acute myelogenous leukemia aren’t inherited.

If you have signs or symptoms of acute myelogenous leukemia, your doctor may recommend you undergo diagnostic tests, including:

  • Blood tests. Most people with acute myelogenous leukemia have too many white blood cells, not enough red blood cells and not enough platelets. The presence of blast cells — immature cells that are usually found in the bone marrow, but not normally circulating in the blood — is another indicator of acute myelogenous leukemia.
  • Bone marrow test. A blood test can suggest leukemia, but it usually takes a bone marrow test to confirm the diagnosis. During a bone marrow biopsy, a needle is used to remove a sample of your bone marrow. Usually, the sample is taken from your hipbone (posterior iliac crest). The sample is sent to a laboratory for testing.
  • Spinal tap (lumbar puncture). In some cases, it may be necessary to remove some of the fluid around your spinal cord to check for leukemia cells. Your doctor can collect this fluid by inserting a small needle into the spinal canal in your lower back.

If your doctor suspects leukemia, you may be referred to a doctor who specializes in cancer (oncologist) or a doctor who specializes in blood and blood-forming tissues (hematologist).

Determining your AML subtype
If your doctor determines you have AML, you may need further tests to determine the extent of the cancer and classify it into one of the eight subtypes of AML. In AML, the subtypes are based on:

  • How mature the cancer cells are at the time of diagnosis
  • How different the cancer cells are from normal cells
  • The number and location of specific changes within the cancer cells’ DNA

Your AML subtype helps determine which treatments may be best for you. Doctors are studying how different types of cancer treatment affect people with different AML subtypes.

Treatment of acute myelogenous leukemia depends on several factors, including the subtype of the disease, your age, your overall health and your preferences. In general, treatment falls into two phases:

  • Remission induction therapy. The purpose of the first phase of treatment is to kill the leukemia cells in your blood and bone marrow. However, remission induction usually doesn’t wipe out all of the leukemia cells, so you need further treatment to prevent the disease from returning.
  • Consolidation therapy. Also called post-remission therapy, maintenance therapy or intensification, this phase of treatment is aimed at destroying the remaining leukemia cells. It’s considered crucial to decreasing the risk of relapse.

Therapies used in these phases include:

  • Chemotherapy. Chemotherapy is the major form of remission induction therapy, though it can also be used for consolidation therapy. Chemotherapy uses chemicals to kill cancer cells in your body. People with AML generally stay in the hospital during chemotherapy treatments because the drugs destroy many normal blood cells in the process of killing leukemia cells. If the first cycle of chemotherapy doesn’t cause remission, you may need it repeated one or two more times.
  • Other drug therapy. Arsenic trioxide (Trisenox) and all-trans retinoic acid (ATRA) are anti-cancer drugs that can be used alone or in combination with chemotherapy for remission induction of a certain subtype of AML called promyelocytic leukemia. These drugs cause leukemia cells with a specific gene mutation to mature and die, or to stop dividing.
  • Biological therapy. Also known as immunotherapy, biological therapy uses substances that bolster your immune system’s response to cancer. Monoclonal antibodies are one form of biological therapy. These antibodies are produced in a laboratory, but they mimic proteins in your immune system (antibodies) that attack foreign substances on leukemic cells. One monoclonal antibody used as a biological therapy in AML is gemtuzumab ozogamicin (Mylotarg). This drug carries a chemical toxin that releases when it attaches to AML cells.
  • Bone marrow stem cell transplant. Bone marrow stem cell transplant may be used for consolidation therapy. Bone marrow stem cell transplant helps re-establish healthy stem cells by replacing unhealthy bone marrow with leukemia-free stem cells that will regenerate healthy bone marrow. Prior to a stem cell transplant, you receive very high doses of chemotherapy or radiation therapy to destroy your leukemia-producing bone marrow. Then you receive infusions of stem cells from a compatible donor (allogeneic transplant). You can also receive your own stem cells (autologous transplant) if you were previously in remission and had your healthy stem cells removed and stored for a future transplant.
  • Clinical trials. Some people with leukemia choose to enroll in clinical trials to try experimental treatments or new combinations of known therapies.

Alternative treatments that may help relieve signs and symptoms include:

  • Acupuncture
  • Aromatherapy
  • Massage
  • Meditation
  • Relaxation exercises