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Acute myeloid leukaemia (AML)

Published by Bupa's health information team, March 2009.

This factsheet is for people who have acute myeloid leukaemia (AML), or who would like information about it.

Acute leukaemia is a cancer of the blood that can spread very rapidly. There are two types of acute leukamia, depending on the type of cells affected: acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML).

About AML
Symptoms of AML
Causes of AML
Diagnosis of AML
Treatment of AML
Living with AML
Further information
Questions and answers
Related topics
Sources

About AML

According to Cancer Research UK, 2,300 people are diagnosed with AML each year. AML tends to affect people over 65 but it can occur at any age. The symptoms develop rapidly, and it can quickly become life-threatening if not treated.

The term leukaemia refers to a group of cancers of the blood cells. If you have leukaemia, the white blood cells become abnormal and divide and grow in an uncontrolled way. Leukaemia is described as acute (growing rapidly) or chronic (growing slowly). Acute leukaemia is divided into two main types - acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML). This factsheet focuses on AML.

The bone marrow produces two main types of white blood cells - lymphoid and myeloid - which work together to fight off infections. AML occurs when too many immature myeloid cells are produced. These fill up the bone marrow so that not enough normal blood cells can be made.

Symptoms of AML

The symptoms of AML are usually due to a lack of healthy white blood cells, red blood cells and platelets. They may also result from the excessive growth of the abnormal immature cells (blasts).

AML symptoms may be vague and seem similar to flu.

Symptoms of AML may include:

feeling generally run down and weak
feeling very tired and breathless
having frequent infections that don't get better
unusual bleeding (eg frequent nosebleeds, heavy periods in women, bleeding from gums and cuts)
increased bruising, or developing a fine rash of dark red spots (called purpura)
blood in the urine or faeces
fever
losing weight unintentionally
pain or discomfort in the abdomen (tummy), due to an enlarged spleen or liver
swollen lymph glands (glands in your neck, groin and under the arms)
aching bones and joints, due to the pressure of too many cells being produced
swollen or bleeding gums
lumps in the skin

These symptoms aren't always due to AML but if you have them, you should visit your GP.

Causes of AML

Some of the risk factors for developing AML are:

gender - men are slightly more likely than women to develop AML
radiation exposure - you are slightly more likely to develop leukaemia if you have had radiotherapy for another cancer
chemical exposure - exposure to cancer-causing substances (carcinogens) such as benzene over a long period of time increases the risk of developing AML
smoking - according to researchers at Cancer Research UK, smoking may be the cause in about two in 10 people with AML
previous cancer treatment - people who have had chemotherapy for some cancers are slightly more likely to develop acute leukaemia many years later, but it's important to weigh up the benefits of treating the cancer against the very small risk of leukaemia years later
genetic disorders - children who have genetic disorders, such as Down's syndrome and have a higher risk of developing AML than other children
being overweight - people who have a body mass index (BMI) of 30 or above have a slightly increased risk of leukaemia
other blood disorders - people who have had diseases that damage the bone marrow (eg aplastic anaemia), may be more likely to develop AML

Diagnosis of AML

Diagnosis, investigation, treatment and follow-up for people with leukaemia usually take place at specialist centres in hospitals.

You may be referred to a doctor who specialises in the treatment of blood disorders called a haematologist. Tests to investigate the type of leukaemia and how far it has progressed include:

blood tests (to test for changes in the blood cells and the presence of abnormal cells)
removal of a sample of bone marrow (biopsy) for analysis under a microscope
specific tests on the leukaemic cells to determine their exact nature (immunophenotyping)
genetic analysis of the chromosomes in the leukaemic cells (cytogenetics)
tissue typing - if your doctor recommends having a bone marrow transplant

These tests and possibly others are all very important because they help determine which treatment is best for you.

Classification of AML

Your leukaemia may also be given a name, or a letter and number to help your doctor plan your treatment. This is called classification. It may be done using one of two different systems, the French American British (FAB) system or the World Health Organization (WHO) system.

FAB system

The main way of classifying AML is using the FAB system. This separates AML into eight sub-types. This is done using a microscope to look for changes in the blood cells taken in a sample from the bone marrow or the blood.

The numbers don't mean the leukaemia you have is more or less severe. Treatment is usually quite similar for the majority of subtypes except M3.

M0, M1, M2 - these subtypes of leukaemia are called myeloblastic and make up about half of all types of AML.
M3 - about one in 10 people get this subtype of AML; it's called promyelocytic.
M4 - two in every 10 people with AML have this subtype; it's called myelomonocytic.
M5 - this subtype, monoblastic AML, affects between one and two in every 10 people with AML.
M6 - this is called erythroleukaemia and is very rare.
M7 - this is called megakaryotic is also very rare.

WHO system

This system is important when planning treatment and predicting your response to treatment. It is based on:

any chromosomal changes (cytogenetics) in the cells
abnormal changes in more than one type of blood cell
if the leukaemia has developed from a previous blood disorder called myelodysplasia
any previous cancer treatment (treatment-related AML)

Granulocytic sarcoma is when cells clump together outside the bone marrow to form a tumour. It can occur anywhere in the body.

Treatment of AML

Chemotherapy

Chemotherapy is the first and main treatment used to destroy the abnormal white blood cells in AML. If you are having chemotherapy for AML, you will probably need to stay in hospital. This is because it's a very demanding treatment - larger doses of chemotherapy medicines are needed for AML than for other types of cancer.

For AML, you will need to have a mixture of chemotherapy medicines, as this has been shown to work better than just one medicine on its own. You will normally have these different medicines in cycles, with a rest period in-between.

There are over 50 chemotherapy medicines, all with slightly different side-effects. Your doctor will give you advice about the side-effects of your specific chemotherapy medicines, and may prescribe other medicines to help reduce any side-effects. Your hair may fall out during treatment but it re-grows once the chemotherapy has stopped.

All trans-retinoic acid (ATRA)

This medicine, which is also known as tretinoin, is a form of vitamin A and, with chemotherapy, is a very effective treatment for the M3 subtype. Side-effects include headache, dry skin and mouth, and feeling sick.

Central line

The chemotherapy medicines are usually fed into a vein and they travel through your bloodstream to nearly all parts of your body. A central line is a long plastic tube that leads to a large blood vessel near the heart. The only part of the tube you can see is where it runs out through a small hole in your chest. A central line is very useful because it means you don't have to have a new drip every time you need a dose of chemotherapy. It can also be used for giving other medicines (eg antibiotics), administering transfusions of blood and blood products (eg certain types of cell) and taking blood samples.

Intrathecal treatment

If AML is found in your central nervous system (brain, spine) you may need treatment in which chemotherapy is injected into the spinal fluid via a lumbar puncture.

Radiotherapy

Radiotherapy may be used to kill any cancer in the central nervous system (brain, spine) that the chemotherapy can't reach but this is rarely used. Before you have a bone marrow or peripheral stem cell transplant, you may be given radiotherapy.

Remission and relapse

The effectiveness of treatment for leukaemia depends on the type and stage of the disease. Acute leukaemia often goes into remission (the symptoms go away; the disease is under control but not necessarily cured). However, many people with acute leukaemia have a relapse (the disease returns).

If the leukaemia returns (relapses), you may need further intensive treatment. This may involve a bone marrow or a stem cell transplant. Bone marrow or stem cell transplants allow much higher doses of chemotherapy to be given.

Bone marrow transplant

A bone marrow transplant involves healthy bone marrow - either from another person (normally a close relative) or from your own bones - which is fed into your bloodstream through a drip. High doses of chemotherapy and sometimes radiotherapy are given before the transplant to destroy all the bone marrow, both abnormal and normal. Bone marrow from another person may also, itself, fight your leukaemia (as the healthy immune cells will fight the leukaemia). This improves the chance of completely curing the leukaemia.

Peripheral blood stem cell transplant

Peripheral blood stem cell transplant involves transplanting stem cells (the most basic type of cell, from which all types of blood cells develop), that have been taken from the blood. Stem cells can be collected (harvested) from your own blood or from another person.

New treatments

There are some new treatments available such as gemtuzumab, which are currently still being tested in clinical trials. Many people with leukaemia take part in clinical trials as new treatments are constantly changing. Your doctor can give you more information about these trials.

Living with AML

After treatment for the cancer, you will have regular check ups with your doctor to detect any evidence of the cancer returning.

Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There may be support groups so you can meet people who may have similar experiences to you. Ask your doctor for advice.

Further information

Macmillan Cancer Support
0808 800 1234
www.macmillan.org.uk
Cancer Research UK
0808 800 4040
www.cancerresearch.org.uk
Leukaemia CARE
0800 169 6680
www.leukaemiacare.org.uk
Leukaemia Research
020 7405 0101
www.lrf.org.uk