What is acute myeloid leukaemia (AML)?

Acute myeloid leukaemia (also called AML or AML leukemia) is a rare cancer of the blood cells. Around 3,100 people in the UK are diagnosed with AML each year. It can develop in people of any age, but is more common in people aged 60 and over.

We have separate information about other types of leukaemia.

How AML develops

Blood cells are made in the bone marrow. This is a spongy material found inside our bones. Every blood cell grows from a stem cell in the bone marrow. Normally, the stem cells make an early stage of the blood cell called a blast. These blasts develop into healthy blood cells.

There are two types of blood stem cell:

  • lymphoid stem cells – make a type of white blood cell called lymphocytes
  • myeloid stem cells – make red blood cells, platelets and all other types of white blood cell.

MACD261 How blood cells divide

In AML, the myeloid stem cells make abnormal blasts that do not develop fully. In most types of AML, blasts that should become white blood cells are affected. In less common types of AML, blasts that should become platelets or red blood cells are affected. The abnormal blasts are called leukaemia cells.

Leukaemia cells cannot do the job of a normal blood cell. They also fill up the bone marrow. This means there is not enough space to make the usual numbers of healthy white blood cells, red blood cells and platelets your body needs.

Types of AML

AML can be grouped into different types. This depends on:

  • the type of blood cells affected
  • gene changes inside the leukaemia cells
  • whether you had a blood disorder called myelodysplasia before developing AML
  • whether the AML is linked to previous chemotherapy treatment (called treatment-related AML or t-AML).

Treatment for most types of AML is usually the same. A type called acute promyelocytic leukaemia (APL) is treated differently.

Symptoms of acute myeloid leukaemia (AML)

Most symptoms of AML are caused by leukaemia cells filling the bone marrow. This means healthy blood cells do not move into the blood as normal. Some people have no symptoms and the leukaemia is found after a routine blood test. More often, symptoms appear over a few weeks and people often feel ill quite quickly.

We have more information about possible symptoms of leukaemia.

Causes of acute myeloid leukaemia (AML)

The cause of AML is not known. There are some things called risk factors that may increase your risk of developing AML. We have more information about the risk factors and causes of AML.

Diagnosis of acute myeloid leukaemia (AML)

Some people are diagnosed with AML after being taken to hospital with symptoms that have developed quickly. Others go to see their GP about symptoms. If it is possible you have leukaemia, you will see a doctor who specialises in diagnosing and treating blood problems. This doctor is called a haematologist.

AML is diagnosed by checking samples of your blood or bone marrow for signs of abnormal cells. The samples are then tested in different ways to find out more about any abnormal cells. We have more information about how tests are used to diagnose leukaemia, and other tests you may have.

If you think you may be pregnant, let your doctor know. Some tests can be harmful to an unborn baby. It is important to talk to your doctor so they can plan your care safely.

Treatment for acute myeloid leukaemia (AML)

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). The aim of treatment for AML is to get rid of the leukaemia cells as quickly as possible, so your bone marrow can work normally again. This is called remission.

Treatment usually starts as soon as possible after diagnosis. Most people in the UK have treatment for AML as part of research called clinical trials. Before you have any treatment, your doctor will explain the different treatments and their side effects. They will also talk to you about things to think about when making treatment decisions.

Treatment plan

Your treatment plan may depend on the type of AML you have and your general health. You may have intensive or non-intensive treatment.

  • Intensive treatment – aims to cure AML or get a long-term remission. For this treatment you stay in hospital for a few weeks at a time. You may stay in for longer if you need treatment to manage side effects, or if you have a stem cell transplant.
  • Non-intensive treatment – aims to control AML for as long as possible. You may be able to have some treatments as an outpatient and go home the same day. This treatment has less risk of serious side effects and may be easier to cope with.

Types of treatment

Treatments for AML include:

  • Chemotherapy

    Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy the leukaemia cells. This is the main treatment for AML.

  • Targeted therapy

    Targeted therapy drugs target something that is helping leukaemia cells grow and survive. This treatment is sometimes given with chemotherapy for some types of AML.

  • ATRA or arsenic trioxide

    If you have a type of AML called acute promyelocytic leukaemia (APL), your treatment may include drugs called ATRA (All Trans-Retinoic Acid) and arsenic trioxide (ATO, Trisenox®).

  • Stem cell transplant

    A stem cell transplant is sometimes given as part of intensive treatment for AML. It may increase the chances of curing AML or keep it in remission for longer.

We have more information about treatment for AML and how it is given.

Side effects of treatment

Leukaemia and its treatment can cause symptoms and side effects. Your doctor will monitor these and give you supportive treatment to prevent or manage them.

We have more information about looking after yourself during treatment and recovery.

Tests during treatment

During treatment, your healthcare team will take blood and bone marrow samples to check for leukaemia cells. The results of these tests help doctors:

  • see how well your treatment has worked
  • make decisions about your next treatment
  • see if the leukaemia is more likely to come back.

If the tests show very small numbers of leukaemia cells, or none at all, the doctor will say you are in remission.

Sometimes very small numbers of leukaemia cells are still found after chemotherapy. This is called minimal residual disease (MRD). It can affect the treatment you need to have.

If AML comes back after a remission (relapse), it may be possible to have more treatment. We have more information about AML relapse.

After acute myeloid leukaemia (AML) treatment

Follow-up

After your treatment, you will have regular check-ups. Your doctor or specialist nurse will tell you what to expect. These follow-up appointments will continue for several years. They are a good time to talk about any questions or worries you have.

Your doctor will examine you. They will ask you how you have been feeling and about any new or ongoing side effects.

You will have regular blood tests to check your general health and the number of normal cells in the blood. Depending on the treatment you had, you may also have bone marrow samples taken to check for signs of leukaemia. Sometimes you may need other tests such as x-rays or scans.

Many people find that they get very anxious before these appointments. This is normal. It may help to get support from family and friends.

If you have any problems, or notice any new symptoms between appointments, talk to your doctor or specialist nurse as soon as possible. Do not wait for your next appointment.

Long term effects of treatment

AML treatment can sometimes cause side effects that are permanent or happen months or years later.

These will not happen to everyone. Your doctor or specialist nurse can explain how likely they are to affect you. They may give you advice about ways to prevent or manage long-term effects.

We have more information about possible long-term or late effects of AML treatment.

Getting support

Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse.

Macmillan can offer emotional, practical and financial help and support.

The organisations below also offer information and support:

  • ACLT (African Caribbean Leukaemia Trust)
    ACLT offers support for people from ethnic minorities affected by leukaemia and related illnesses.
  • Anthony Nolan
    Anthony Nolan is the UK’s largest stem cell and bone marrow register.
  • Blood Cancer UK
    Blood Cancer UK is a blood cancer research charity that provides information and support on any type of blood cancer.

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