Definition

Acute myelogenous leukemia (AML) is a cancer of the blood and bone marrow. With AML, the bone marrow makes abnormal blood cells including:

• Myeloblasts, a type of immature white blood cell
• Red blood cells (RBCs)—carry oxygen
• Platelets—a blood cell that helps blood to clot

These abnormal cells crowd out the healthy cells. AML gets worse quickly.

AML may also be the end state of chronic myelogenous leukemia (CML).

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Causes

Cancer happens when cells divide without control or order. These cells grow together to form a tumor. They can invade and damage nearby tissues. They can also spread to other parts of the body.

It is not clear what causes changes in the cells. It is likely a combination of genes and environment.

Risk Factors

AML is most common in people 65 years of age or older. Other things that may raise the risk are:

• Exposure to high levels of radiation
• Previous chemotherapy or radiation treatment
• History of a bone marrow disorders, such as:
  • Polycythemia vera, thrombocythemia, or myelodysplastic syndrome
  • Certain other leukemias, such as CML
• Smoking
• Certain genetic disorders
• Exposure to the chemical benzene
• CT scans during childhood or adolescence

Symptoms

Symptoms of AML may be:

• Painless lumps in the neck, underarms, stomach, or groin
• Red or purple spots under the skin
• Easy bruising or bleeding—including bleeding of the gums or nose
• Fever, tiredness, weakness, and paleness
• Problems breathing and chest pain
• Loss of hunger and weight loss
• Bone or joint pain

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. The doctor will check for swelling of the liver, spleen, or lymph nodes. You may be referred to a cancer doctor.

Tests will be done to look for abnormal cells. They may include:

• Blood tests
• Bone marrow aspiration and biopsy—to remove and test a sample of bone marrow
• Lumbar puncture —to test the fluid around the brain and spinal cord for cancer

The doctor may do more tests to learn about the leukemia. These tests will help guide treatment. Tests may include:

• Cytogenetic analysis—to look for problems with genes
• Immunophenotyping—to check the type of leukemia
• Imaging tests to check bodily structures, including:
  • Chest x-ray
  • CT scan
  • MRI scan
  • Ultrasound
  • Gallium scan and bone scan

AML is then classified as one of 8 subtypes. This helps the doctor make a treatment plan.

Treatment

Treatment of AML is usually done in two phases:

• Remission induction therapy—to kill leukemia cells
• Maintenance therapy—to kill any remaining leukemia cells that could grow and cause a relapse

Treatment options include:

• Chemotherapy by mouth, injection, or IV—to kill cancer cells.
• External radiation therapy—to treat bone pain or kill cancer cells that have or may spread to the brain or spinal cord
• Stem cell transplant—blood cells given from a donor
• Monoclononal antibody therapy—blocks the growth of cancer cells
• Biologic therapy—helps the body fight cancer
• Treatments for side effects—such as medicines and blood transfusions

Prevention

There are no current guidelines to prevent AML. Since smoking is a risk for AML, quitting smoking may help.