Acute Myeloid Leukemia Library
Learn about Acute Myeloid Leukemia
Adult acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes a large number of abnormal blood cells.
Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. It is the most common type of acute leukemia in adults. This type of cancer usually gets worse quickly if it is not treated. AML is also called acute myelogenous leukemia and acute nonlymphocytic leukemia.
Leukemia may affect red blood cells, white blood cells, and platelets.
Normally, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell. A lymphoid stem cell becomes a white blood cell.
A myeloid stem cell becomes one of three types of mature blood cells:
- Red blood cells that carry oxygen and other substances to all tissues of the body.
- Granulocytes, which are white blood cells that help fight infection and disease.
- Platelets that form blood clots to stop bleeding.
In AML, the myeloid stem cells usually become a type of immature white blood cell called myeloblasts (or myeloid blasts). The myeloblasts in AML are abnormal and do not become healthy white blood cells. Sometimes in AML, too many stem cells become abnormal red blood cells or platelets. These abnormal white blood cells, red blood cells, or platelets are also called leukemia cells or blasts. Leukemia cells can build up in the bone marrow and blood so there is less room for healthy white blood cells, red blood cells, and platelets. When this happens, infection, anemia, or easy bleeding may occur.
The leukemia cells can spread outside the blood to other parts of the body, including the central nervous system (brain and spinal cord), skin, and gums. Sometimes leukemia cells form a solid tumor called a myeloid sarcoma. Myeloid sarcoma is also called extramedullary myeloid tumor, granulocytic sarcoma, or chloroma.
There are different subtypes of AML.
Most AML subtypes are based on how mature (developed) the cancer cells are at the time of diagnosis, and how different they are from normal cells.
Acute promyelocytic leukemia (APL) is a subtype of AML. This leukemia occurs when genes on chromosome 15 switch places with some genes on chromosome 17, and an abnormal gene called PML::RARA is made. The PML::RARA gene sends a message that stops promyelocytes (a type of white blood cell) from maturing. Problems with severe bleeding and blood clots may occur. This is a serious health problem that needs treatment as soon as possible. APL usually occurs in middle-aged adults.
Smoking, previous chemotherapy treatment, and exposure to radiation may affect the risk of AML.
Anything that increases a person's chance of getting a disease is called a risk factor. Not every person with one or more of these risk factors will develop AML, and it can develop in people who don't have any known risk factors. Talk with your doctor if you think you may be at risk. Possible risk factors for AML include the following:
- Being male.
- Older age.
- Having had treatment with chemotherapy or radiation therapy in the past.
- Being exposed to radiation in the environment (such as nuclear radiation) or to the chemical benzene.
- Having a personal history of a blood disorder such as myelodysplastic syndrome.
- Having certain syndromes or inherited disorders.
Signs and symptoms of AML include fever, feeling tired, and easy bruising or bleeding.
The early signs and symptoms of AML may be like those caused by the flu or other common diseases. Check with your doctor if you have any of the following:
- Paleness or loss of normal skin color.
Less common signs or symptoms may be caused by clusters of leukemia cells in the central nervous system (CNS) or testicles, or a tumor of myeloid cells called a chloroma.
Symptoms of acute leukemia often develop between 4 and 6 weeks before diagnosis.
Tests that examine the blood and bone marrow are used to diagnose AML.
In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures:
- Complete blood
count (CBC): A procedure in which a sample of blood is drawn and
checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the sample made up of red blood cells.
- Peripheral blood smear: A procedure in which a sample of blood is checked for blast cells, the number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.
- Flow cytometry: A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of the cells, such as size, shape, and the presence of tumor (or other) markers on the cell surface. The cells from a sample of a patient’s blood, bone marrow, or other tissue are stained with a fluorescent dye, placed in a fluid, and then passed one at a time through a beam of light. The test results are based on how the cells that were stained with the fluorescent dye react to the beam of light. This test is used to help diagnose and manage certain types of cancers, such as leukemia and lymphoma.
- Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
- Tumor biopsy: A biopsy of a tumor made up of leukemia cells, also known as a myeloid sarcoma (chloroma), may be done.
- Cytogenetic analysis: A laboratory test in which the chromosomes of cells in a sample of blood or bone marrow are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in certain chromosomes may be a sign of cancer. Cytogenetic analysis is used to help diagnose cancer, plan treatment, or find out how well treatment is working. Other tests, such as fluorescence in situ hybridization (FISH), may also be done to look for certain changes in the chromosomes.
- Molecular testing: A laboratory test to check for certain genes, proteins, or other molecules in a sample of blood or bone marrow. Molecular tests also check for certain changes in a gene or chromosome that may cause or affect the chance of developing AML. A molecular test may be used to help plan treatment, find out how well treatment is working, or make a prognosis.
- Immunophenotyping: A laboratory test that uses antibodies to identify cancer cells based on the types of antigens or markers on the surface of the cells. This test is used to help diagnose specific types of leukemia. For example, a cytochemistry study may test the cells in a sample of tissue using chemicals (dyes) to look for certain changes in the sample. A chemical may cause a color change in one type of leukemia cell but not in another type of leukemia cell.
- Reverse transcription–polymerase chain reaction test (RT–PCR): A laboratory test in which the amount of a genetic substance called mRNA made by a specific gene is measured. An enzyme called reverse transcriptase is used to convert a specific piece of RNA into a matching piece of DNA, which can be amplified (made in large numbers) by another enzyme called DNA polymerase. The amplified DNA copies help tell whether a specific mRNA is being made by a gene. RT-PCR can be used to check the activation of certain genes that may indicate the presence of cancer cells. This test may be used to look for certain changes in a gene or chromosome, which may help diagnose cancer. This test is used to diagnose certain types of AML including acute promyelocytic leukemia (APL).
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis and treatment options depend on the following:
- The age of the patient. Older age at diagnosis may be linked to lower remission rates and more complications.
- Whether the leukemia has spread to the central nervous system.
- Whether the patient has a systemic infection at the time of diagnosis.
- Whether the patient has a very high white blood cell count at the time of diagnosis.
- The subtype of AML.
- Whether the patient received chemotherapy or radiation therapy in the past to treat a different cancer.
- Whether there is a history of a blood disorder such as myelodysplastic syndrome.
- Whether the cancer has been treated before or recurred (come back).
It is important that acute leukemia be treated right away.
Frequently Used Leukemia Chemotherapy Drugs
- CytosarU (cytarabine)
- Idamycin PFS (idarubicin)
- Tabloid (thioguanine)
- Adriamycin (doxorubicin)
- Cerubidine (daunorubicin)
- Elspar (asparaginase)
- Cytoxan (cytoxan)
- Mylotarg (gemtuzumab ozogamicin)
- Cytoxan Injection (cyclophosphamide injection)
- Oncovin (vincristine)
- Prednisone Intensol (prednisone)
- Rydapt (midostaurin)
- Vyxeos (daunorubicin and cytarabine lipid complex injection)
- Idhifa (enasidenib)
- Mylotarg (gemtuzumab ozogamicin injection)
- Tibsovo (ivosidenib)
- Xospata (gilteritinib)
- Daurismo (glasdegib)
- Onureg (azacitidine)
- Rezlidhia (olutasidenib)
- Vanflyta (quizartinib)