Acute myeloid leukaemia

What is it?

AML is a rare cancer of the blood and bone marrow. Bone marrow, found in the centre of most bones, makes blood cells. In AML it makes large numbers of abnormal, immature white blood cells that crowd out the healthy ones. It is the most common type of acute leukaemia in adults. 'Acute' means it gets worse quickly, so treatment needs to start fast.

It can happen at any age, but it is more likely after 60. Being male may also raise the risk. The risk is also higher if you smoke, had chemotherapy or radiotherapy in the past, have another blood disorder, have a genetic condition such as Down's syndrome, or were often exposed to high levels of the chemical benzene. It is not always clear what causes it.

The first signs

The signs are often not obvious at first and can feel like flu. They usually come on quickly, over a few weeks:

• feeling very tired or weak;
• looking paler than usual (on brown or black skin, check the palms or the inside of the eyelids);
• getting out of breath;
• bleeding or bruising easily;
• a high temperature, or getting ill a lot or taking longer than usual to recover from illnesses;
• aching bones or joints, a swollen tummy or swollen glands.

They can be caused by many other conditions, but they need checking.

How doctors find out

Your family doctor usually arranges an urgent blood test, and may send you to a hospital specialist or straight to hospital. The main tests are blood tests and a bone marrow biopsy: a small sample of marrow is taken with a needle from the hip bone or breastbone, usually after numbing the skin. Gene tests on the leukaemia cells help choose the treatment. You may also need a lumbar puncture (a little fluid taken from the lower back) and scans. Blood results can come within a few days; other tests take a few weeks.

Current treatment

Intensive chemo, sometimes a stem cell transplant

Will it get worse?

Without treatment, AML gets worse quickly, but it is often treatable. How serious it is depends on the type of AML, your age and your general health. In older people, the leukaemia may be less likely to go into remission. Even after remission, the leukaemia can come back, which is why treatment carries on afterwards. When AML cannot be cured, treatment aims to control it, ease symptoms and help you live longer.

Medicines: what helps, and what to watch for

Chemotherapy is the main treatment, usually several medicines together. Intensive treatment aims to cure the leukaemia and is usually given in hospital. Non-intensive treatment aims to control it for as long as possible; it is usually given at home and has fewer side effects. Targeted medicines can be added, for example when the leukaemia has a change in the FLT3 gene. One type, acute promyelocytic leukaemia, may be treated with ATRA and arsenic trioxide.

Good to know:

• Treatment comes in phases: first to clear the leukaemia from the blood and marrow, then more treatment to kill any cells that are left;
• AML and chemotherapy lower your blood counts, so you are watched closely and may need blood and platelet transfusions;
• You may get antibiotics and antifungal medicines to prevent or treat infections;
• You have regular check-ups, tests and scans during and after treatment;

Exercise and diet help too

Tiredness is one of the most common problems and can continue for months after treatment. After treatment, exercise can help your body and your mood: start gently, for example with walking, and build up slowly. You can go swimming once your white blood cell count is back to normal and you no longer have a central line. A good, balanced diet might help you feel stronger and recover more quickly. Your nurse can refer you to a dietitian or a physiotherapist.

• After a stem cell transplant, your team may give you food-safety advice for the first few months, such as eating only freshly cooked food;

A transplant, for some people

A stem cell or bone marrow transplant replaces the damaged blood-making cells with healthy ones. First you get high-dose chemotherapy, sometimes with radiotherapy, and then the stem cells are given back to you through an infusion. They can be your own cells or come from a donor. It may be offered if the leukaemia is likely to come back, has come back, or other treatments are not working.

Is there a cure?

Sometimes. Intensive treatment aims to cure AML, and more than 1 in 4 adults live 3 years or more and may be cured. For others, treatment aims to keep it under control. New treatments are being tested in clinical trials.

See the 836 trials you can join

Median survival

About 15 months with azacitidine and venetoclax, for people who cannot have intensive chemotherapy

Measured in: Previously untreated AML in people who could not have intensive chemotherapy (median age 76): the VIALE-A trial (431 patients)

Sources

Written in plain words by Frontlight from these pages:

1. NCI PDQ: Acute Myeloid Leukemia Treatment (PDQ®) – Patient Version
2. NHS: Acute myeloid leukaemia – Symptoms
3. NHS: Acute myeloid leukaemia – Treatment
4. NHS: Acute myeloid leukaemia – What is AML?
5. NHS: Acute myeloid leukaemia – Causes
6. NHS: Acute myeloid leukaemia – Tests and next steps
7. Cancer Research UK (charity): Coping with acute myeloid leukaemia
8. Cancer Research UK (charity): Diet and physical activity after AML
9. NCI PDQ: Adult Acute Myeloid Leukemia Treatment (PDQ®) – Health Professional Version
10. The New England Journal of Medicine: Azacitidine and Venetoclax in Previously Untreated Acute Myeloid Leukemia