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Acute myeloid leukaemia (AML)

Acute myeloid leukaemia (AML) is a cancer of the blood that can develop quickly and usually needs immediate treatment. It most commonly affects people over the age of 60, but can happen at any age. In the UK there are 3000 new cases of AML diagnosed each year.

The word leukaemia refers to a group of cancers of the bone marrow and white blood cells. The name for the type of leukaemia you get is based on how quickly the disease develops and the type of cells that are affected. Acute leukaemia develops quickly, as opposed to chronic leukaemia which develops slowly.

The cells affected in AML are the myeloid cells in your bone marrow. These are immature cells which normally develop into white blood cells. In AML these cells don’t develop properly. Instead, they rapidly form lots of immature, abnormal cells called blasts (or myeloblasts). These blasts start to fill up your bone marrow and stop it from producing enough healthy blood cells. They also start to build up in your blood, and sometimes your liver and spleen. The abnormal cells don’t work properly so your body doesn’t have the different types of blood cell it needs to stay healthy.

You may hear other names used for AML, such as acute myelogenous leukaemia and acute myeloblastic leukaemia.

There are different types of AML. Your doctor will offer you tests to find out the type you have. The type of AML you have may affect which treatment is best for you, and may also affect how well your treatment works.

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How cancer develops
Cells begin to grow in an uncontrolled way

Details

  • Symptoms Symptoms of acute myeloid leukaemia

    The main symptoms of acute myeloid leukaemia (AML) happen because your bone marrow can’t make enough healthy white blood cells, red blood cells and platelets. Symptoms of AML include:

    • feeling tired and weak
    • being breathless, especially during exercise
    • frequent infections
    • unexplained bleeding, such as nosebleeds, bleeding gums and heavy periods in women
    • bruising easily
    • a rash of dark red/purple spots (called petechiae)
    • fever

    Other symptoms are caused by leukaemia cells collecting in various parts of your body. These include:

    • a full feeling or pain in your upper abdomen (tummy) caused by your liver and spleen being enlarged
    • swelling of your gums
    • lumps under your skin caused by leukaemia cells

    Your symptoms may come on quickly – over a matter of days or weeks – or they may take months to develop.

    Most people with these symptoms don’t have AML but if you have them, see your GP.

  • Diagnosis Diagnosis of acute myeloid leukaemia

    Your GP will ask about your symptoms and examine you. If your symptoms suggest that a blood test may be helpful, your GP will arrange this. If your blood test shows that you have acute myeloid leukaemia (AML) you’ll normally be admitted to hospital within 24 hours. You’ll then be under the care of a haematologist (a doctor who specialises in conditions of the blood).

    Your doctor will offer you tests to confirm the diagnosis and investigate which type of leukaemia you have. These tests will include:

    • more blood tests – to check your blood cells and also see how well your kidneys and liver are working
    • a bone marrow biopsy. Your doctor will use a needle to remove a small sample of your bone marrow to be examined under a microscope
    • a chest X-ray to check your lungs

    If you’re diagnosed with AML, your doctor may offer you further tests on your bone marrow sample to find out what type it is. This can help them decide the most appropriate treatment. Further tests include:

    • specific tests on the leukaemia cells to confirm exactly what type they are
    • tests to look at the genetic make-up of the leukaemia cells
  • Treatment Treatment of acute myeloid leukaemia

    You may hear your doctor referring to your treatment for acute myeloid leukaemia (AML) in two phases.

    • Remission induction to get rid of the cancer.
    • Consolidation treatment to prevent the cancer coming back (a relapse).

    Treatment for AML can last many months and is likely to cause some side-effects. These include hair loss, increased tiredness and feeling sick. Your doctor will discuss the probable risks and benefits of treatment in your individual circumstances.

    Remission induction

    Remission is when no leukaemia cells (or only a very few) can be detected in your bone marrow. You will also have normal levels of healthy blood cells in your blood. The main treatment for causing remission in AML is chemotherapy. This uses medicines to destroy cancer cells in your bone marrow. At first, you’ll probably need to stay in hospital for about a month. This is because the treatment is quite demanding and you’ll need support from hospital staff.

    You’re likely to be given a mixture of chemotherapy medicines. It’s thought that using a combination works better than just one medicine on its own. You will usually have these different medicines in cycles, with rest periods in between. Most patients will need a total of four cycles of chemotherapy which usually takes about six months to complete.

    If you have a type of AML known as acute promyelocytic leukaemia (APML), you’ll also be given a medicine called all trans-retinoic acid (ATRA). ATRA (or tretinoin) works by making your abnormal white blood cells develop into normal cells and is given as a tablet. It’s important that you receive this medicine as soon after being diagnosed as possible because it can prevent complications from developing.

    Consolidation treatment

    Once your AML has gone into remission you’ll need to have further treatment to prevent it from returning. This is called consolidation treatment and may involve the following.

    • Further courses of intensive chemotherapy. Patients with AML will usually have between one and three cycles of consolidation treatment.
    • A bone marrow (stem cell) transplant. This is when somebody else donates healthy bone marrow or stem cells, which are transferred into your body.

    New treatments

    Many possible new treatments for AML are being tested in clinical trials all the time. These include new chemotherapy medicines, and different types of stem cell transplant and biological therapies that change chemical pathways inside cells. You may be able to take part in a clinical trial to test one of these new treatments. See our frequently asked questions, below, for information about taking part in a clinical trial. And have a chat with your doctor about it.

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  • Causes Causes of acute myeloid leukaemia

    Doctors don’t yet completely understand why people get acute myeloid leukaemia (AML), although lots of research is being done to try to find out. However, they do know that there are several things that increase the risk of getting AML.

    • Exposure to radiation.
    • Smoking. This is thought to double your risk of getting AML.
    • Exposure to certain cancer-causing substances (carcinogens) such as benzene.
    • Previous cancer treatment. If you’ve had chemotherapy in the past, you’re slightly more likely to develop acute leukaemia. It’s important to remember that this small risk of leukaemia is outweighed by the benefits you got from having your cancer treated.
    • Having certain other blood disorders, including myelodysplasia and chronic myeloid leukaemia.
    • Genetic disorders such as Down's syndrome.
  • How will my treatment affect my daily life? How will my treatment for acute myeloid leukaemia (AML) affect my daily like?

    Answer

    Having treatment for AML will probably bring a lot of changes to your daily life for a while. These changes may depend, to some extent, on your usual activities and how you react to the type of treatment you have.

    More information

    Getting a diagnosis of AML can bring great changes to your life because you may get ill quite quickly and need immediate treatment in hospital. While you’re having repeated courses of chemotherapy, you’ll need to spend a lot of time in hospital with only short breaks in between. These are usually less than a week. During these breaks you’re likely to feel very tired, which can affect how you cope with your daily activities. This tiredness may continue even after resting and can carry on for some time after your treatment has finished.

    Ask for support and help from your family and friends to help you manage with your daily routine. Try to do some gentle exercise, eat a healthy, balanced diet with plenty of fruit and vegetables, and get plenty of rest. These will all help you cope with tiredness.

    There are likely to be practical issues such as financial, work and legal matters to organise. Your doctor will be able to put you in touch with people who can help you manage these things.

    You may have very mixed emotions or negative feelings that can continue once you’ve finished treatment. Everyone deals with their diagnosis differently and it’s important that you feel able to talk about things with someone if you want to. This might be a family member or friend, or someone involved in your treatment.

    There are lots of organisations and support groups that offer help and advice if you want to contact them. It may help you and your family to talk to other people who’ve been through a similar experience. See our resources section for some useful contact details.

  • I'm in remission - is it likely to come back? My acute myeloid leukaemia (AML) is in remission – is it likely to come back?

    Answer

    It’s possible that your AML will come back, even if you’re in remission for several years. This can depend on a number of things, including your age and what type of AML you have.

    More information

    Treatment for AML aims to get rid of the cancer and also to prevent it from coming back (relapsing). How successful this is varies according to your age, the type of AML that you have and how well the chemotherapy works. About half of all people under the age of 50 who are diagnosed with AML will live for at least five years. Some of these people will be cured, but for others the AML will come back. In people who are over 50 when they are diagnosed with AML, about one out of eight will live for five years or more.

    If your AML does come back, it’s possible to have further treatment. This will involve more chemotherapy first and if this works, you may be offered a bone marrow (stem cell) transplant. If it isn’t possible to get your AML into remission again, your doctor may recommend treatments to relieve your symptoms.

    Your doctor will discuss with you the best options for your personal circumstances.

  • Should I take part in clinical trials? Should I take part in clinical trials for cancer treatment?

    Answer

    Treatment for AML is often given as part of a clinical trial. Talk to your doctor to find out whether this is an option for you.

    More information

    Clinical trials are used to test how well a treatment works and how safe it is before it can be made widely available to people. AML can be difficult to treat and doctors are always trying to improve the treatments they use for it. Because of this many patients getting treatment for AML take part in a clinical trial. This may be to test a new medicine or treatment, or to test a new combination of existing treatments. In the UK, most hospitals enter patients into the National Cancer Research Institute AML trials. This is one of the largest multicentre trials worldwide and recruits several thousand patients.

    If your doctor suggests taking part in a clinical trial they will discuss the details with you. It’s important that you understand exactly what it involves and it’s your decision whether you take part or not. The following are some questions that you may wish to ask.

    • What is the aim of the trial?
    • How will the trial be of benefit to me and other people?
    • What are the potential side-effects, risks or benefits?
    • What happens if my condition gets worse?
    • Can I decide to stop doing the trial once I’ve started it?
    • What will happen after the trial is finished?

    Remember, new treatments aren’t always better. Sometimes treatments don't work as well or side-effects are worse than existing treatments. Your doctor should give you enough information to help you decide whether you wish to take part in a clinical trial.

  • Resources Resources

    Further information

    Sources

    • Kumar, P, Clark, M. Clinical medicine. 8th ed. Edinburgh: Saunders; 2012
    • Acute myelogenous leukaemia. BMJ Best Practice. www.bestpractice.bmj.com, published 4 February 2015
    • Acute myelogenous leukemia. Medscape. www.emedicine.medscape.com, published 15 August 2014
    • Acute myeloid leukaemia. PatientPlus. patient.co.uk/patientplus.asp, published 6 September 2013
    • Referral guidelines for suspected cancer. National Institute for Health and Care Excellence (NICE), 2005. www.nice.org.uk
    • Haematological malignancies. Oxford handbook of oncology (online). Oxford Medicine Online. www.oxfordmedicine.com, published June 2011 (online version)
    • Map of Medicine. Acute leukaemia. International View. London: Map of Medicine; 2013 (Issue 4)
    • Cancer statistics for the UK. Cancer Research UK. www.cancerresearchuk.org, published 16 June 2014
    • Acute myeloid leukaemia. Cancer Research UK. www.cancerresearchuk.org, published 12 February 2014
    • Tretinoin (Vesanoid, ATRA). Cancer Research UK. www.cancerresearchuk.org, published 24 January 2014
    • Coping with cancer. Cancer Research UK. www.cancerresearchuk.org, published 6 March 2014
    • Adult acute myeloid leukemia treatment (PDQ). National Cancer Institute. www.cancer.gov, published 9 January 2015
    • About clinical trials. Medical Research Council, Clinical Trials Unit. www.ctu.mrc.ac.uk, accessed 3 March 2015
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    Reviewed by Dylan Merkett, Bupa Health Content Team, July 2015.

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