Learn About Acute Myeloid Leukemia (AML)

What is Acute Myeloid Leukemia (AML)?

Leukemia that begins in myeloid cells is called myelogenous, myeloblastic or myeloid leukemia. Acute Myeloid Leukemia (AML) is a cancer of the blood cells in which too many myeloid cells (a type of white blood cell) are made by the bone marrow. AML is a type of cancer that grows quickly without treatment. It is the most common form of acute leukemia that affects adults.

There are many different sub-categories or subtypes of AML with different prognoses (likely outcome of a disease). Some AML subtypes are treated differently from others. There are many lab tests used to determine which subtype is present. These tests include flow cytometry, cytogenetics, mutational analysis, and the most recent test called SNaPshot.

These tests may indicate:

1. whether or not a bone marrow transplant will be involved in the AML treatment plan and/or
2. which new drugs (called monoclonal antibodies, immunoconjugates or small molecule inhibitors) might be useful in leukemia treatment

If tests show that Acute Promyelocytic Leukemia (APL) is present, then a very different chemotherapy treatment plan is generally used.

What are the symptoms of AML?

The abnormal leukemia cells travel throughout the body in blood vessels just like all blood cells. Sometimes they become trapped by the bones, lungs, or skin. People who have AML usually do not feel well. Common AML symptoms include:

• Fevers, night sweats
• Recurring infections
• Fatigue, feeling weak
• Shortness of breath during normal physical activity
• Pale skin
• Bleeding and bruising easily or tiny red spots on skin
• Pain in bones or joints
• Headaches

Leukemia symptoms may be vague and can also be caused by other illnesses. Call your treatment team if you have any of these symptoms.

How is Acute Myeloid Leukemia diagnosed?

• Full Medical History by your doctor
• Full physical exam
• Blood tests: Complete Blood Count (CBC) to check the number of white blood cells, red blood cells and platelets in your blood. Leukemia may cause low or high white blood cell count. Learn more about understanding your blood counts
• Blood Cell Examination: a test on the blood cells where the blood cells are stained with a colored dye and looked at through a microscope. It is also called a blood smear. AML usually has a high number of immature cells, or blast cells, in the blood
• Biopsy: a test to remove a very small piece of tissue to look for cancer cells in your bone marrow. The tissue usually comes from the back of your hipbone. The test is done with numbing medicine to reduce the discomfort of the procedure. The tissue removed is looked at under the microscope by a pathologist (tissue doctor) to check for leukemia cells. A bone marrow aspiration and biopsy are usually done together in the doctor’s office. Bone marrow aspiration: using a hollow needle to remove the liquid sample of bone marrow into a syringe. Bone marrow biopsy: capturing the solid piece of the bone marrow that stays in the bone marrow needle after it is removed from the patient. This solid piece is placed in a jar
• Cytogenetic Analysis: a test to look for changes in the genetic material inside of the leukemia cells. Abnormal chromosomes may be found, and this may help to identify the type of leukemia present and influence the plan of treatment
• Flow Cytometry: a test of surface proteins on cells. Certain patterns on leukemia cells indicate characteristics unique to certain leukemias. This test is most important in telling the difference between AML and ALL
• Chest x-ray: an x-ray picture of your heart and lungs and other internal organs in your chest. This is important to identify whether or not there are swollen lymph glands in your chest

What is the Treatment for AML?

There are many treatment options for people with AML. The choice of treatment depends on different factors, including:

• your white blood cell count
• the type and sub-type of AML from your cytogenetic tests
• your age and general health
• whether you have a serious infection at the time of diagnosis and
• whether you have had cancer in the past

AML is a cancer that grows quickly without treatment, so treatment should be started right away. The goal of treatment is to remove leukemia symptoms that are present and to destroy the leukemia forming cells. This is called remission. After this point is reached, more treatment is usually given to prevent a return of leukemia symptoms. This is called a relapse. Leukemia treatment options include:

• Chemotherapy – drugs given with the goal to destroy leukemia cells. Chemotherapy may be given by mouth, into a vein (IV), or sometimes through a catheter in the chest that stays in place. Chemotherapy is usually given in intervals called cycles. Aggressive chemotherapy for AML usually requires several weeks in the hospital
• Stem Cell Transplant – This treatment allows you to be treated with high doses of drugs, radiation, or both. The high doses destroy both the normal and abnormal cells in the bone marrow. Then, you receive healthy stem cells through a large vein. The healthy stem cells can come from you (saved before receiving the high dose treatment). This is called an autologous transplant. More likely the healthy stem cells will come from a family member, volunteer donor, or blood saved from an umbilical cord. This is called an allogeneic transplant. New blood cells grow from the newly transplanted stem cells, replacing the ones that were destroyed by high dose leukemia treatment

Clinical Trials

Clinical trials are research studies of new drugs, new combinations of drugs or already approved drugs being studied to treat patients in new/different ways. They may include new drug doses or new ways (schedules) to give the drugs. Clinical trials are run under strict guidelines. Their purpose is to help find out whether new cancer treatments are safe and effective or better than the standard (current) treatment. At Massachusetts General Hospital, there are several clinical trials open for the treatment of leukemia that use the latest in cancer treatments.