Acute myeloid leukaemia

What is it?

AML is a rare cancer of the blood and bone marrow.⁴ Bone marrow, found in the centre of most bones, makes blood cells.¹ In AML it makes large numbers of abnormal, immature white blood cells that crowd out the healthy ones.¹ It is the most common type of acute leukaemia in adults. 'Acute' means it gets worse quickly, so treatment needs to start fast.^1,3

It can happen at any age, but it is more likely after 60. Being male may also raise the risk.^2,5,1 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.⁵ It is not always clear what causes it.⁵

The first signs

The signs are often not obvious at first and can feel like flu.^2,1 They usually come on quickly, over a few weeks:²

• feeling very tired or weak;²
• looking paler than usual (on brown or black skin, check the palms or the inside of the eyelids);²
• getting out of breath;²
• bleeding or bruising easily;²
• a high temperature, or getting ill a lot or taking longer than usual to recover from illnesses;²
• aching bones or joints, a swollen tummy or swollen glands.²

They can be caused by many other conditions, but they need checking.²

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.² 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.^6,1 Gene tests on the leukaemia cells help choose the treatment.¹ You may also need a lumbar puncture (a little fluid taken from the lower back) and scans.⁶ Blood results can come within a few days; other tests take a few weeks.⁶

Current treatment

Intensive chemo, sometimes a stem cell transplantSource: NHS

Will it get worse?

Without treatment, AML gets worse quickly, but it is often treatable.^1,3 How serious it is depends on the type of AML, your age and your general health.⁴ In older people, the leukaemia may be less likely to go into remission.¹ Even after remission, the leukaemia can come back, which is why treatment carries on afterwards.¹ When AML cannot be cured, treatment aims to control it, ease symptoms and help you live longer.³

Medicines: what helps, and what to watch for

Chemotherapy is the main treatment, usually several medicines together.³ Intensive treatment aims to cure the leukaemia and is usually given in hospital.³ Non-intensive treatment aims to control it for as long as possible; it is usually given at home and has fewer side effects.³ Targeted medicines can be added, for example when the leukaemia has a change in the FLT3 gene.^3,1 One type, acute promyelocytic leukaemia, may be treated with ATRA and arsenic trioxide.¹

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;¹
• AML and chemotherapy lower your blood counts, so you are watched closely and may need blood and platelet transfusions;¹
• You may get antibiotics and antifungal medicines to prevent or treat infections;^1,3
• You have regular check-ups, tests and scans during and after treatment;³

Exercise and diet help too

Tiredness is one of the most common problems and can continue for months after treatment.⁷ After treatment, exercise can help your body and your mood: start gently, for example with walking, and build up slowly.⁸ You can go swimming once your white blood cell count is back to normal and you no longer have a central line.⁸ A good, balanced diet might help you feel stronger and recover more quickly.⁸ Your nurse can refer you to a dietitian or a physiotherapist.⁷

• 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;⁸

A transplant, for some people

A stem cell or bone marrow transplant replaces the damaged blood-making cells with healthy ones.^3,1 First you get high-dose chemotherapy, sometimes with radiotherapy, and then the stem cells are given back to you through an infusion.¹ They can be your own cells or come from a donor.¹ It may be offered if the leukaemia is likely to come back, has come back, or other treatments are not working.³

Is there a cure?

Sometimes.^9,3 Intensive treatment aims to cure AML, and more than 1 in 4 adults live 3 years or more and may be cured.^9,3 For others, treatment aims to keep it under control.³ New treatments are being tested in clinical trials.¹

See the 835 trials you can join

Median survival

About 15 months with azacitidine and venetoclax, for people who cannot have intensive chemotherapySource: The New England Journal of Medicine, 2020

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