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Cancer Types

Acute Myeloid Leukemia

Acute Myeloid Leukemia Facts

What is Acute Myeloid Leukemia?

What is Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is a cancer of cells in the blood, bone marrow and lymph nodes. AML is also called acute nonlymphocytic leukemia, acute myeloblastic leukemia, or acute granulocytic leukemia.

In AML, the bone marrow begins producing large numbers of abnormal blasts. Instead of producing all three types of mature blood cells, the bone marrow begins to produce only one type, usually immature white blood cell blasts called myeloblasts. These myeloblasts then overrun the bloodstream. They can also invade the brain, skin, ovaries and testes, and other organs. AML cells occasionally form a solid tumor called an isolated granulocytic sarcoma or chloroma.

AML is one of four types of leukemia. Like acute lymphocytic leukemia (ALL), AML appears and progresses quickly, but begins in a different type of cell. Chronic lymphocytic leukemia and chronic myelogenous leukemia both progress more slowly.

Acute Myeloid Leukemia Risk Factors

Smoking, previous chemotherapy treatment, and exposure to radiation may affect the risk of developing adult AML.

Possible risk factors for AML include the following:

  • Being male
  • Smoking, especially after age 60
  • Having had treatment with chemotherapy or radiation therapy in the past
  • Having had treatment for childhood acute lymphoblastic leukemia (ALL) in the past
  • Being exposed to atomic bomb radiation or the chemical benzene
  • Having a history of a blood disorder such as myelodysplastic syndrome

Acute Myeloid Leukemia, What to Look For

Possible signs of adult AML include fever, feeling tired, and easy bruising or bleeding.

The early signs of AML may be like those caused by the flu or other common diseases. A doctor should be consulted if any of the following problems occur:

  • Fever
  • Shortness of breath
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Weakness or feeling tired
  • Loss of appetite or weight loss

Acute Myeloid Leukemia Tests

Tests that examine the blood and bone marrow are used to detect (find) and diagnose adult AML.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:

  • The number of red blood cells, white blood cells, and platelets
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells
  • The portion of the blood sample made up of red blood cells

Peripheral blood smear: A procedure in which a sample of blood is checked for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.

Bone marrow biopsy and aspiration: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views the samples under a microscope to look for abnormal cells.

Cytogenetic analysis: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are certain changes in the chromosomes in the lymphocytes. For example, sometimes in ALL, part of one chromosome is moved to another chromosome. This is called the Philadelphia chromosome.

Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant (cancerous) lymphocytes began from the B lymphocytes or the T lymphocytes.

Acute Myeloid Leukemia Stages

There is no standard staging system for adult Acute Myeloid Leukemia. The disease is described as untreated, in remission, or recurrent.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on:

  • The age of the patient
  • The subtype of AML
  • Whether the patient received chemotherapy in the past to treat a different cancer
  • Whether there is a history of a blood disorder such as myelodysplastic syndrome
  • Whether the cancer has spread to the central nervous system
  • Whether the cancer has been treated before or recurred (come back)

Acute Myeloid Leukemia Treatment

There are different types of treatment for patients with adult acute myeloid leukemia.

Different types of treatment are available for patients with adult acute myeloid leukemia (AML). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

The treatment of adult AML usually has 2 phases...

Remission induction therapy: This is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.

Maintenance therapy: This is the second phase of treatment. It begins after the leukemia is in remission. The purpose of maintenance therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse. This phase is also called remission continuation therapy.

Standard types of treatment used:

– Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Intrathecal chemotherapy may be used to treat adult AML that has spread, or may spread to the brain and spinal cord. Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the subtype of the cancer being treated and whether it has spread to the brain and spinal cord.

– Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

– Stem cell transplantation

Stem cell transplantation is a method of giving chemotherapy and replacing blood-forming cells that are abnormal or destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.


Untreated Adult Acute Myeloid Leukemia


Standard treatment of untreated adult acute myeloid leukemia (AML) during the remission induction phase depends on the subtype of AML and may include the following:

  • Combination chemotherapy
  • High-dose combination chemotherapy
  • Stem cell transplantation using donor stem cells
  • All-trans retinoic acid (ATRA) plus chemotherapy
  • Intrathecal chemotherapy


Adult Acute Myeloid Leukemia in Remission

Standard treatment of adult AML during the remission phase depends on the subtype of AML and may include the following:

  • Combination chemotherapy
  • High-dose chemotherapy, with or without radiation therapy, and stem cell transplantation using the patient's stem cells
  • High-dose chemotherapy and stem cell transplantation using donor stem cells


Recurrent Adult Acute Myeloid Leukemia

Standard treatment of recurrent adult AML depends on the subtype of AML and may include the following:

  • Combination chemotherapy
  • Biologic therapy with monoclonal antibodies
  • Stem cell transplantation
  • Low-dose radiation therapy as palliative therapy to relieve symptoms and improve quality of life
  • Arsenic trioxide therapy

Acute Myeloid Leukemia Risk Factors

Smoking, previous chemotherapy treatment, and exposure to radiation may affect the risk of developing adult AML.

Possible risk factors for AML include the following:

  • Being male
  • Smoking, especially after age 60
  • Having had treatment with chemotherapy or radiation therapy in the past
  • Having had treatment for childhood acute lymphoblastic leukemia (ALL) in the past
  • Being exposed to atomic bomb radiation or the chemical benzene
  • Having a history of a blood disorder such as myelodysplastic syndrome

What to Look for

Possible signs of adult AML include fever, feeling tired, and easy bruising or bleeding.

The early signs of AML may be like those caused by the flu or other common diseases. A doctor should be consulted if any of the following problems occur:

  • Fever
  • Shortness of breath
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Weakness or feeling tired
  • Loss of appetite or weight loss

Acute Myeloid Leukemia Tests

Tests that examine the blood and bone marrow are used to detect (find) and diagnose adult AML.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:

  • The number of red blood cells, white blood cells, and platelets
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells
  • The portion of the blood sample made up of red blood cells

Peripheral blood smear: A procedure in which a sample of blood is checked for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.

Bone marrow biopsy and aspiration: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views the samples under a microscope to look for abnormal cells.

Cytogenetic analysis: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are certain changes in the chromosomes in the lymphocytes. For example, sometimes in ALL, part of one chromosome is moved to another chromosome. This is called the Philadelphia chromosome.

Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant (cancerous) lymphocytes began from the B lymphocytes or the T lymphocytes.

Stages of Acute Myeloid Leukemia

There is no standard staging system for adult Acute Myeloid Leukemia. The disease is described as untreated, in remission, or recurrent.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on:

  • The age of the patient
  • The subtype of AML
  • Whether the patient received chemotherapy in the past to treat a different cancer
  • Whether there is a history of a blood disorder such as myelodysplastic syndrome
  • Whether the cancer has spread to the central nervous system
  • Whether the cancer has been treated before or recurred (come back)

Types of Treatment for Acute Myeloid Leukemia

There are different types of treatment for patients with adult acute myeloid leukemia.

Different types of treatment are available for patients with adult acute myeloid leukemia (AML). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

The treatment of adult AML usually has 2 phases...

Remission induction therapy: This is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.

Maintenance therapy: This is the second phase of treatment. It begins after the leukemia is in remission. The purpose of maintenance therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse. This phase is also called remission continuation therapy.

 

Standard types of treatment used:

– Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Intrathecal chemotherapy may be used to treat adult AML that has spread, or may spread to the brain and spinal cord. Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the subtype of the cancer being treated and whether it has spread to the brain and spinal cord.

– Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

– Stem cell transplantation

Stem cell transplantation is a method of giving chemotherapy and replacing blood-forming cells that are abnormal or destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.


Untreated Adult Acute Myeloid Leukemia


Standard treatment of untreated adult acute myeloid leukemia (AML) during the remission induction phase depends on the subtype of AML and may include the following:

  • Combination chemotherapy
  • High-dose combination chemotherapy
  • Stem cell transplantation using donor stem cells
  • All-trans retinoic acid (ATRA) plus chemotherapy
  • Intrathecal chemotherapy


Adult Acute Myeloid Leukemia in Remission

Standard treatment of adult AML during the remission phase depends on the subtype of AML and may include the following:

  • Combination chemotherapy
  • High-dose chemotherapy, with or without radiation therapy, and stem cell transplantation using the patient's stem cells
  • High-dose chemotherapy and stem cell transplantation using donor stem cells


Recurrent Adult Acute Myeloid Leukemia

Standard treatment of recurrent adult AML depends on the subtype of AML and may include the following:

  • Combination chemotherapy
  • Biologic therapy with monoclonal antibodies
  • Stem cell transplantation
  • Low-dose radiation therapy as palliative therapy to relieve symptoms and improve quality of life
  • Arsenic trioxide therapy

Side Effects of Acute Myeloid Leukemia

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