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Acute Myelogenous Leukemia—Adult(AML—Adult; Acute Myeloid Leukemia—Adult; Acute Myeloblastic Leukemia—Adult; Acute Granulocytic Leukemia—Adult; Acute Nonlymphoblastic Leukemia—Adult)
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 white blood cell; white blood cells fight infection
  • Red blood cells (RBCs)—carry oxygen
  • Platelets—makes blood clot, stops bleeding in cuts or bruises

AML begins in immature myeloblasts and progresses very quickly. It may also be the end state of chronic myelogenous leukemia (CML).

White Blood Cells

White Blood Cells

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Causes

Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but it is probably a combination of genetics and environment.

Risk Factors

Current or past smoking is strongly associated with AML. Risk is compounded by how much you smoked and for how long. AML is more common in men.Other factors that may increase your chance of AML include:

Symptoms

AML may cause:

  • Fever
  • Shortness of breath
  • Paleness (a sign of anemia )
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Weakness
  • Tiredness
  • Loss of appetite
  • Weight loss
  • Bone pain
  • Joint pain
  • Enlarged liver and spleen
  • Swelling, pain, and bleeding of the gums
  • Painless lumps in the neck, underarms, stomach, or groin
Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done, paying particular attention to swelling of the liver and spleen. The doctor will also look for swelling in lymph nodes in the armpits, groin, or neck. You will likely be referred to an oncologist. This is a doctor who focuses on treating cancer.

Tests may include the following:

  • Blood tests
  • Your doctor may need to collect fluid samples through:
  • Routine microscopic exam—examination of a sample of blood, bone marrow, lymph node tissue, or cerebrospinal fluid
  • Bone, blood marrow, lymph node tissue, or cerebrospinal fluid tests—to distinguish between types of leukemia
  • Cytogenetic analysis—a test to look for certain changes of the chromosomes (genetic material) of the lymphocytes
  • Immunophenotyping—examination of the proteins on cell surfaces and the antibodies produced by the body; to distinguish lymphoblastic from myeloid leukemia and determine types of therapy
  • Gallium scan and bone scan—injection of a radioactive chemical into the bloodstream to detect areas of cancer or infection
  • Your doctor may need detailed pictures of structures inside your body. These can be made with:

After AML is identified, it can be classified as one of eight subtypes. These subtypes are based on the type of cell from which leukemia developed. Classification is important. It can help make a prognosis and design a treatment plan.

Treatment

Talk with your doctor about the best plan for you. Treatment of AML usually involves 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

Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms. This includes pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body. While this will focus on cancer cells, some healthy cells are also killed.

Some AML may spread to the brain and spinal cord. In this case, intrathecal chemotherapy may be used. Chemotherapy drugs are placed directly into the spinal column.

Radiation Therapy

Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors. For AML, external radiation therapy is used.

The radiation is directed at the tumor from outside the body. This type of treatment is used for AML that has spread, or may spread, to the brain and spinal cord. It can also be used to treat bone pain that comes from bone affected by the leukemia.

Chemotherapy With Stem Cell Transplant

Chemotherapy is followed by a transplantation of stem cells (immature blood cells). These will replace blood-forming cells destroyed by cancer treatment. Stem cells are removed from the blood or bone marrow of the patient or a donor. They are then infused into the patient.

Other Drug Therapy

These drugs may be used with certain types of leukemia. They can kill leukemia cells, stop them from dividing, or help them mature into white blood cells:

  • Arsenic trioxide
  • All-trans retinoic acid (ATRA)
Monoclonal Antibody Therapy

This therapy uses antibodies made in a lab. The antibodies help to identify substances on cancer cells or on normal cells that may help cancer grow. The antibodies attach to these substances. This kills the cancer cells, blocking their growth, or preventing them from spreading.

Biologic Therapy

Biologic therapy uses medications or substances made by the body. The substance is used to increase or restore the body's natural defenses against cancer. This type of therapy is also called biological response modifier therapy. It is still being tested in clinical trials.

Treatment of Side Effects

Patients will suffer side effects from the leukemia and from therapy. These include:

  • A reduction in red blood cells (anemia)
  • Reduced numbers of platelets that assist in blood clotting (thrombocytopenia)
  • Decreased numbers of the white blood cells that fight infection

Anemia may lead to fatigue. If severe, it can complicate respiratory or cardiac disease. Thrombocytopenia may lead to bleeding and bruising. Decreased numbers of white blood cells can leave a patient more vulnerable to infection.

Your doctor may prescribe a number of different treatments to decrease these side effects. Drugs are available to increase production of normal blood cells. In addition, when your counts are particularly low, blood transfusions or changes in daily activities may be needed. These steps will reduce the chance of fatigue, bleeding, or infection.

Prevention

There are no current guidelines to prevent AML. Smoking is the most common risk factor. Talk to your doctor about how you can successfully quit .

RESOURCES:

American Cancer Society
http://www.cancer.org

The Leukemia and Lymphoma Society
http://www.leukemia-lymphoma.org

CANADIAN RESOURCES

BC Cancer Agency
http://www.bccancer.bc.ca

Canadian Cancer Society
http://www.cancer.ca

References:

Adult acute myeloid leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/adultAML/Patient/. Updated July 30, 2012. Accessed October 30, 2012.

Childhood acute myeloid leukemia/other myeloid malignancies (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/childAML/patient. Updated August 13, 2012. Accessed October 30, 2012.

Larson RA, Sievers EL, Stadtmauer EA, et al. Final report of the efficacy and safety of gemtuzumab ozogamicin (Mylotarg) in patients with CD33-positive acute myeloid leukemia in first recurrence. Cancer. 2005 Oct 1;104(7):1442-52.

Leukemia–acute myeloid. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=82. Accessed October 30, 2012.

6/25/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food and Drug Administration. FDA: Pfizer voluntarily withdraws cancer treatment Mylotarg from US market. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm216448.htm. Published June 21, 2010. Accessed June 25, 2010.

5/12/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Davis AS, Viera AJ, et al. Leukemia: an overview for primary care. Am Fam Physician. 2014 May 1;89(9):731-8.

8/26/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Fircanis S, Merriam P, et al. The relation between cigarette smoking and risk of acute myeloid leukemia: An updated meta-analysis of epidemiological studies. Am J Hematol. 2014;89(8):E125-E132.



Last reviewed December 2013 by Mohei Abouzied, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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