Acute myelogenous leukemia in adults

Acute myelogenous leukemia (AML) is a type of cancer that develops in the bone marrow. This is the soft tissue in the bone that helps make blood cells. The cancer grows from cells that would normally become white blood cells.

The acute phase means that the disease progresses rapidly and usually follows an aggressive course.

Causes

AML is one of the most common forms of leukemia in adults.

AML is more common in men than in women.

The bone marrow helps the body fight infections and produce other components of the blood, but in people with AML there are many abnormal immature cells in the bone marrow. These cells multiply very rapidly and are replaced by healthy blood cells. As a result, people with AML are more susceptible to infections. There is also an increased risk of bleeding due to the reduced number of healthy blood cells.

In many cases, medical professionals cannot identify the cause of AML. However, there are a number of factors that may contribute to the development of certain types of leukemia, including AML, among them

Blood disorders such as true polycythemia, prothrombemia and myeloproliferative disorders.

Certain chemicals (e.g., benzene).

Certain chemotherapeutic agents, including so-called alkylating agents such as etoposide.

Exposure to certain harmful chemicals and substances.

Radiation

Decreased immunity due to organ transplants.

Genetic problems may also be a cause of AML.

Symptoms

There are no specific symptoms of AML. Causes of AML may include

Bleeding from the nose

Bleeding or swollen gums (rare)

Bruising

leg pain and tenderness

Fever and tiredness

Heavy menstrual flow

Paleness of the face

Shortness of breath (worse with exercise)

Weight loss

Exams and Tests

A health care provider will perform a physical examination. There may be signs of a swollen spleen, liver, or lymph nodes. Tests performed include the following

A complete blood count (CBC) may show anemia and a low platelet count. The white blood cell count may be high, low, or normal.

A bone marrow sample and biopsy will show if leukemia cells are present.

If your doctor decides that you have this type of leukemia, further testing will be done to determine the specific type of AML. The subtype is determined based on changes (mutations) in certain genes and how the leukemia cells look under a microscope.

Treatment

Treatment involves the use of drugs (chemotherapy) to kill the cancer cells. Most types of AML are treated with more than one type of chemotherapy drug.

Chemotherapy can also destroy normal cells. It can cause side effects such as

an increased risk of bleeding

an increased risk of infection (your doctor may ask you to stay away from other people to avoid infection)

Weight loss (extra calories will be taken in).

Mouth sores

Other supportive treatments for AML may include

Antibiotics to treat infections

Red blood cell transfusions to prevent anemia

Platelet transfusions to control bleeding

A bone marrow transplant (stem cell transplant) may also be attempted. Several factors play a role in making this decision, including the following

Your age and general health

Specific genetic changes in your leukemia cells

The availability of donors

Support groups

Joining a support group can help ease the stress of illness. By sharing experiences with others who have similar experiences and problems, you will feel less alone.

Expectations (prognosis)

If there are no signs of AML on a bone marrow biopsy, the disease is considered to be in remission. The prognosis depends on your overall health and the genetic subtype of the AML cells.

Remission does not imply cure. Additional treatment, such as chemotherapy or a bone marrow transplant, is usually required.

Once treated, younger AML patients have a better prognosis than those who develop the disease later. The five-year survival rate of older people is much lower than that of younger people. Experts believe this is partly because younger people can tolerate stronger chemotherapy drugs. Older people with leukemia also tend to be more resistant to the latest treatments.

If the cancer does not recur within five years of diagnosis, it is probably cured.

When should I see my doctor?

You should make an appointment with your health care provider if you are

You are developing symptoms of AML

You have had AML and your fever has not gone down or you have other signs of infection.

Preventive measures

Always wear protective equipment when working around radiation or chemicals that may be associated with leukemia.

Also known as

Acute myelogenous leukemia; AML; Acute granulocytic leukemia; Acute nonlymphocytic leukemia (NHL)

Instructions for patients

Discharge from the hospital following bone marrow transplant