Learn about this cancer that forms in the bone and bone marrow. Treatments include medications and bone marrow transplant.
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 (my-uh-LOHJ-uh-nus) leukemia because it affects a group of white blood cells called the myeloid cells, which normally develop into the 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.
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:
Make an appointment with a doctor if you develop any signs or symptoms that seem unusual or that worry you.
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.
Factors that may increase your risk of acute myelogenous leukemia (AML) include:
Many people with AML have no known risk factors, and many people who have risk factors never develop the cancer.
If you have signs or symptoms of acute myelogenous leukemia, your doctor may recommend that you undergo diagnostic tests, including:
Bone marrow test. A blood test can suggest leukemia, but it usually takes a bone marrow test to confirm the diagnosis.
During a bone marrow biopsy, a needle is used to remove a sample of your bone marrow. Usually, the sample is taken from your hipbone. The sample is sent to a laboratory for testing.
If your doctor suspects leukemia, you may be referred to a doctor who specializes in blood cancer (hematologist or medical oncologist).
If your doctor determines that you have AML, you may need further tests to determine the extent of the cancer and classify it into a more specific AML subtype.
Your AML subtype is based on how your cells appear when examined under a microscope. Special laboratory testing also may be used to identify the specific characteristics of your cells.
Your AML subtype helps determine which treatments may be best for you. Doctors are studying how different types of cancer treatment affect people with different AML subtypes.
Your doctor uses your AML subtype and other information to determine your prognosis and decide on your treatment options. Other types of cancer use numerical stages to indicate your prognosis and whether your cancer has spread, but there are no stages of acute myelogenous leukemia.
Instead, the seriousness of your condition is determined by:
In a bone marrow aspiration, a health care provider uses a thin needle to remove a small amount of liquid bone marrow, usually from a spot in the back of your hipbone (pelvis). A bone marrow biopsy is often done at the same time. This second procedure removes a small piece of bone tissue and the enclosed marrow.
Treatment of acute myelogenous leukemia depends on several factors, including the subtype of the disease, your age, your overall health and your preferences.
In general, treatment falls into two phases:
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.
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).
You can also receive your own stem cells (autologous transplant) if you were previously in remission and had your healthy stem cells removed and stored for a future transplant.
No alternative treatments have been found helpful in treating acute myelogenous leukemia. But some complementary and alternative treatments may relieve the symptoms you experience due to cancer or cancer treatment.
Alternative treatments that may help relieve symptoms include:
Acute myelogenous leukemia is an aggressive form of cancer that typically demands quick decision-making. That leaves people with a new diagnosis faced with important decisions about a disease they may not yet understand. Here are some tips for coping:
Learn enough to make decisions about your care. The term "leukemia" can be confusing because it refers to a group of cancers that aren't all that similar except for the fact that they affect the bone marrow and blood. You can waste a lot of time researching information that doesn't apply to your kind of leukemia. To avoid that, ask your doctor to write down as much information about your specific disease as possible. Then narrow your search for information accordingly.
Write down questions for your doctor before each appointment, and look for information in your local library and on the internet. Good sources include the National Cancer Institute, the American Cancer Society, and the Leukemia & Lymphoma Society.
Make an appointment with your family doctor if you have signs and symptoms that worry you. If your doctor suspects you may have leukemia, you'll likely be referred to a doctor who specializes in blood cell diseases (hematologist).
Because appointments can be brief, and because there's often a lot of information to discuss, it's a good idea to be prepared. Here's some information to help you get ready and know what to expect from your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For acute myelogenous leukemia, some basic questions to ask include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions.
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow time later to cover other points you want to address. Your doctor may ask:
Avoid activities that worsen your signs and symptoms. For instance, try to take it easy if you're feeling fatigued.