What is acute myeloid leukemia (AML)?

Cancer starts when cells change (mutate) and grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Leukemia is different from most other types of cancer. 

Leukemia cells don’t often form tumors. Leukemia is cancer that starts in the bone marrow. The bone marrow is where new blood cells are made. It's the thick, sponge-like tissue in the center of certain bones. 

When a person has leukemia, the body makes too many abnormal blood cells. They can crowd out healthy cells in the bone marrow. This leads to not making enough of all the different types of blood cells. Leukemia cells travel throughout your body in your blood. So leukemia can affect organs all over your body.

Acute myeloid leukemia (AML) is when myeloid stem cells in the bone marrow grow out of control. AML is also called acute myeloblastic leukemia, acute myelocytic leukemia, and acute myelogenous leukemia.

AML starts when changes happen in very early or immature forms of myeloid stem cells. These cells normally mature into red blood cells, white blood cells, and platelets. But in AML, the myeloid stem cells are damaged and don’t mature like they should. Instead, they often become immature white blood cells called myeloblasts, or blasts.

People with AML have too many white blood cells in their blood. But these cells aren't normal and don't help fight infection. In fact, people with AML are more likely to get infections. AML can also lead to not enough red blood cells. This is called anemia, and it can cause extreme tiredness (fatigue). AML can lead to not enough platelets, too. This causes easy bleeding and bruising. 

AML comes in many subtypes. They’re based on what type of cells the leukemia starts in and how mature the cells are. The subtype of AML you have can affect both your treatment and your prognosis (outlook). 

Who is at risk for acute myeloid leukemia? 

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change. 

The risk factors for AML include:

  • Smoking
  • Being exposed to certain chemicals, like benzene
  • Having had chemotherapy or radiation treatments in the past
  • Being accidentally exposed to very high levels of radiation
  • Having certain rare genetic diseases
  • Having certain bone marrow disorders, such as myelodysplastic syndromes or aplastic anemia
  • Having a family history of AML
  • Being older in age
  • Being a man

Talk with your healthcare provider about your risk factors for AML and what you can do about them.

Can acute myeloid leukemia be prevented?

There’s no sure way to prevent AML. Few risk factors can be controlled to help reduce your risk. But you can stop smoking and limit exposure and protect yourself if you work with chemicals.

Are there screening tests for acute myeloid leukemia?

There are currently no regular screening tests for AML. Screening tests are done to check for disease in people who don’t have symptoms.

What are the symptoms of acute myeloid leukemia?

Common symptoms of AML can include:

  • Easy bleeding and bruising
  • Fevers with no clear cause
  • Frequent infections or infections that don't go away
  • Feeling weak
  • Feeling tired even after rest (fatigue)
  • Pale skin
  • Trouble breathing or shortness of breath
  • Chest pain
  • Dizziness
  • Headaches
  • Aches in bones and joints
  • Swollen lymph nodes
  • Swollen liver or spleen (may feel like fullness under your ribs)
  • Loss of appetite
  • Unplanned weight loss
  • Rashes of tiny flat red spots, caused by bleeding
  • Night sweats

Many of these may be caused by other more common health problems. But it’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is acute myeloid leukemia diagnosed?

AML may be diagnosed when a person sees a healthcare provider because of symptoms. If your healthcare provider thinks you may have AML, exams and tests will be needed to be sure. Your healthcare provider will ask you about your health history, symptoms, risk factors, and family history of disease. A physical exam will be done. 

You may also have 1 or more of these tests:

  • Blood tests (many different kinds)
  • Bone marrow aspiration and biopsy
  • Lumbar puncture (spinal tap)

After a diagnosis of AML, you’ll likely need other tests. These help your healthcare providers learn more about your cancer. They can help determine the subtype of the AML and the chromosome changes in your AML cells. Tests can also show if infection or the AML is affecting any organs. All this information helps your healthcare team figure out the best treatment plan for you.

How is acute myeloid leukemia treated?

AML tends to grow very quickly and often needs to be treated right away. 

Your treatment choices depend on things like:

  • The type of AML you have
  • Test results
  • Your age
  • Your overall health
  • The chromosome changes found in your AML cells

The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. They aren't used to treat AML.

Systemic treatment is used to destroy or control cancer cells that have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. This is the way most people with AML are treated.

You may have just one treatment or a combination of treatments. Tests will be done during treatment to see how well it's working.  

Treatments for AML include:

  • Chemotherapy
  • Targeted therapy
  • Other medicines, such as all-trans retinoic acid (ATRA) and arsenic trioxide
  • Stem cell transplant with high-dose chemotherapy

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects? 

Cancer treatment can damage normal cells, as well as cancer cells. This causes side effects like hair loss, mouth sores, loss of appetite, and vomiting. Many side effects get better after treatment ends, but some can last the rest of your life.

Talk with your healthcare provider about side effects linked to your treatment. Be sure you know what to watch for. There are often ways to manage and even prevent side effects.

Coping with acute myeloid leukemia

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are tips:

  • Talk with your family or friends.
  • Ask your healthcare team or social worker for help.
  • Speak with a counselor.
  • Talk with a spiritual advisor, such as a minister or rabbi.
  • Ask your healthcare team about medicines for depression or anxiety.
  • Keep socially active.
  • Join a cancer support group.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

  • Eat a healthy diet, with a focus on high-protein foods.
  • Drink plenty of water, fruit juices, and other liquids.
  • Keep physically active.
  • Rest as much as needed.
  • Talk with your healthcare team about ways to manage treatment side effects.
  • Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

  • New symptoms or symptoms that get worse
  • Signs of an infection, such as a fever or chills
  • Side effects of treatment that affect your daily function or don’t get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is advised and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.