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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. It's called myelogenous leukemia because it affects a group of white blood cells called the myeloid cells, which normally develop into 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.

Symptoms

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 of acute myelogenous leukemia include:

  • Fever;
  • 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

Be sure to see your doctor if you develop any signs or symptoms that seem unusual or that worry you.

Causes

Acute myelogenous leukemia occurs when a bone marrow cell develops changes (mutations) in its genetic material or DNA. A cell's DNA contains the instructions that tell a cell what to do. Normally, the DNA tells the cell to grow at a set rate and to die at a set time. In acute myelogenous leukemia, the mutations tell the bone marrow cell to continue growing and dividing. When this happens, blood cell production becomes out of control. 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, but doctors have identified factors that increase the risk.

Risk factors

Factors that may increase your risk of acute myelogenous leukemia (AML) include:

  • Increasing age. The risk of acute myelogenous leukemia increases with age. Acute myelogenous leukemia is most common in adults age 65 and older.
  • Gender. Men are more likely to develop acute myelogenous leukemia than are women.
  • Previous cancer treatment. People who've had certain types of chemotherapy and radiation therapy may have a greater risk of developing AML.
  • Exposure to radiation. People exposed to very high levels of radiation, such as survivors of a nuclear reactor accident, have an increased risk of developing AML.
  • Dangerous chemical exposure. Exposure to certain chemicals, such as benzene, is linked to a greater risk of AML.
  • Smoking. AML is linked to cigarette smoke, which contains benzene and other known cancer-causing chemicals.
  • Other blood disorders. People who've had another blood disorder, such as myelodysplasia, myelofibrosis, polycythemia vera or thrombocythemia, are at greater risk of developing AML.
  • Genetic disorders. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of AML.

Treatment

Treatment of acute myelogenous leukemia depends on several factors, including the subtype of the disease, your age, your overall health and your preferences.

Treatment is divided  into two phases:

  • Remission induction. 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. Also called post-remission therapy or maintenance therapy, 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, it can be repeated. After remission is achieved, maintenance therapy (chemotherapy or targeted therapy) is given.
  • Targeted therapy. Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your leukemia cells will be tested to see if targeted therapy may be helpful for you. Targeted therapy can be used alone or in combination with chemotherapy for induction therapy and consolidation therapy.
  • Bone marrow transplant. A bone marrow transplant, also called a stem cell transplant, may be used for consolidation therapy. A bone marrow transplant helps reestablish healthy stem cells by replacing unhealthy bone marrow with leukemia-free stem cells that will regenerate healthy bone marrow.

Prior to a bone marrow 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).  Some people with leukemia choose to enroll in clinical trials to try experimental treatments or new combinations of known therapies.