Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is a cancer of primitive white blood cells in the bone marrow. It is the most common type of acute leukemia seen in adults, accounting for 80 percent of such cases. There are two major types:

  • Acute Myeloid Leukemia, Non-APL — Characterized by the overproduction of primitive myeloid cells called blasts, resulting in reduced production of neutrophils (infection-fighting white blood cells), red blood cells and platelets. The prognosis of this form of AML depends on the presence (and type) or absence of chromosome changes in the leukemia cells. It is treated with chemotherapy.
  • M3 – Acute Promyelocytic Leukemia (APL) — Characterized by the presence of atypical promyelocytes in the bone marrow and peripheral blood, this type of leukemia can be associated with severe bleeding. A translocation between chromosomes 15 and 17 commonly occurs and suggests a better prognosis. This condition represents approximately 10 percent to 15 percent of AML cases. It is treated with chemotherapy, a vitamin A derivative called ATRA, and arsenic.

Typically AML comes on suddenly, within days or weeks. Less often, a patient has been ill for a few months or may have a prior history of Myelodysplastic Syndrome.

AML makes people sick primarily by interfering with normal bone marrow function. The leukemia cells replace and crowd out the normal cells of the bone marrow, thereby causing low blood cell counts. This insufficient number of red blood cells results in a condition called anemia, which causes a person to be tired and pale. Lack of platelets can make you more susceptible to bleeding and bruising, especially in the skin, nose and gums.

Lowered levels of normal white blood cells increase the risk of infection. Although infections can be of any type, typical symptoms include:

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First, your doctor will perform a physical examination and look for swelling in the liver, spleen, groin, neck and lymph nodes under your arm.

Your doctor will order a CBC test, which is a complete blood count that measures the amount of white and red blood cells and platelets in your blood. In addition, a sample of your blood is examined under a microscope to see what the cells look like and to determine the number of mature cells as well as leukemia cells, called blasts. Although blood tests may reveal that a patient has leukemia, they do not always indicate the type of leukemia.

In order to further check for leukemia cells or to identify what type of leukemia a patient has, a hematologist (blood disorder specialist) or oncologist (cancer specialist) performs a bone marrow aspiration and biopsy. During this procedure, the doctor inserts a needle into a large bone (usually the hip or back pelvis) and removes a small amount of liquid bone marrow (aspiration) and a piece of the spongy tissue inside the bone (biopsy).

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Patients with AML undergo extensive evaluation including:

  • Medical history and physical examination
  • Blood tests
  • Heart tests
  • Bone marrow aspiration with biopsy
  • Immunophenotyping of the marrow to define protein expression in leukemia cells

Doctors review this information to confirm the AML subtype. Treatment begins as soon as possible and varies by age, general condition and cytogenetics results. For most patients age 69 or younger, the goal is a cure. Typical therapy includes three phases:

  • First phase — Induction chemotherapy
  • Second phase — Consolidation chemotherapy, which may include stem cell transplantation
  • Third phase — In some cases, blood or marrow transplant (BMT)

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Reviewed by health care specialists at UCSF Medical Center.