Acute myeloid leukaemia (AML)

About acute myeloid leukaemia

The term leukaemia refers to a group of cancers of the white blood cells and bone marrow. Bone marrow produces white blood cells, of which there are two types – lymphocytes and myeloid cells. Myeloid cells are responsible for producing many other types of blood cell, including red blood cells and platelets. Usually these divide in a controlled way but if you have leukaemia, your white blood cells start to divide and grow in an uncontrolled way, and don’t develop properly.

Leukaemia can be described as either acute (growing rapidly) or chronic (growing slowly). Acute leukaemia is divided into two main types – AML and acute lymphoblastic leukaemia (ALL). This factsheet focuses on AML.

In AML, the myeloid cells that aren’t developing fully start to fill up your bone marrow and prevent it from producing enough healthy blood cells. These abnormal cells can't function properly so don’t produce the different types of cell that your body needs.

Over 2,000 people are diagnosed with AML each year in the UK.

Types of acute myeloid leukaemia

There are many different groups or subtypes of AML and they can be classified according to different systems (see our frequently asked questions for more information). Your doctor will tell you which type of AML you have.

Occasionally, leukaemia appears to be a mixture of AML and ALL. This type of leukaemia is known as acute biphenotypic leukaemia.

Symptoms of acute myeloid leukaemia

Symptoms of AML include:

  • feeling tired, weak and breathless
  • frequent infections that don't get better
  • unexplained bleeding, such as nosebleeds, bleeding gums and heavy periods in women
  • bruising easily
  • a rash of dark red/purple spots (called purpura)
  • fever
  • weight loss

Your symptoms may come on very quickly – over a matter of days or weeks. These symptoms are similar to those for other conditions so it’s easy to confuse them.

Less common symptoms of AML include:

  • aching bones – this is because of the abnormal cells being produced
  • lumps under your skin caused by leukaemia cells

These symptoms aren’t always caused by AML but if you have them, see your GP.

Causes of acute myeloid leukaemia

The exact reasons why you may get AML aren’t fully understood at present, but much research is being done to try to find out. However, doctors do know that there are several things that increase the risk of developing AML. These include:

  • exposure to radiation
  • smoking – this is thought to be the cause for up to two out of every 10 people who get AML
  • exposure to certain cancer-causing substances (carcinogens) such as benzene, which is found in household paint and solvents
  • previous cancer treatment – if you have had chemotherapy in the past, you’re slightly more likely to develop acute leukaemia, but it's important to weigh up the benefits of treating the cancer against the very small risk of developing leukaemia years later
  • having certain autoimmune conditions, such as rheumatoid arthritis or ulcerative colitis (however, it’s not clear whether it’s the condition or the medicine you take for it that increases your risk)
  • genetic disorders such as Down's syndrome
  • being male
  • being overweight or obese – if you have a body mass index (BMI) of 30 or above
  • having certain other blood disorders

Diagnosis of acute myeloid leukaemia

Your GP will ask about your symptoms and examine you. If he or she thinks you may have leukaemia, you will be asked to have a blood test and may then be referred to a haematologist (a doctor who specialises in conditions of the blood).

You will then have some tests to confirm the diagnosis and investigate which type of leukaemia you have. These tests will include:

  • more blood tests
  • a bone marrow biopsy – your doctor uses a needle to remove a small sample of your bone marrow to be examined under a microscope (there are two ways in which a biopsy may be done)
  • further tests such as a chest X-ray or an electrocardiogram (ECG) to check your lungs and heart

If you’re diagnosed with leukaemia, you may have further tests to find out what type it is. This can help to determine the most appropriate treatment for you. Further tests that you may have include:

  • specific tests on the leukaemia cells to confirm exactly what type they are
  • tests to look at the genetic make-up of the leukaemia cells

Treatment of acute myeloid leukaemia

You may hear your doctor referring to your treatment in two phases:

  • remission induction – to get rid of the cancer
  • consolidation treatment – to prevent the cancer coming back (a relapse)

Treatment for AML can last many months and is likely to cause some side-effects. These include hair loss, increased tiredness and feeling sick.

Remission induction

Chemotherapy

The main treatment for AML is chemotherapy, which uses medicines to destroy cancer cells in your bone marrow. Initially, you will probably need to stay in hospital for about a month because larger doses of chemotherapy medicines are used to treat acute leukaemia than for other types of cancer.

You’re likely to be given a mixture of chemotherapy medicines because it’s thought that using a combination works better than just one medicine on its own. You will usually have these different medicines in cycles, with rest periods in between.

If you have a type of AML known as acute promyelocytic leukaemia (APML), you will also be given a medicine called all trans-retinoic acid (ATRA). ATRA (or tretinoin) works by making your abnormal white blood cells develop into normal cells. It’s important that you receive this medicine as soon as possible after being diagnosed as it can prevent serious complications from developing.

Consolidation treatment

Once your AML has gone into remission (this is when no leukaemia cells can be detected in your bone marrow using routine tests), you will need to have further treatment to prevent it from returning.

Consolidation treatment may involve:

  • further courses of intensive chemotherapy
  • a bone marrow (stem cell)transplant – this is when somebody else (preferably a brother or sister) donates healthy bone marrow or stem cells, which are transferred into your body

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