Table of ContentsView AllTable of ContentsDisease CharacteristicsEarly Signs and SymptomsLater Stage SymptomsCauses and Risk FactorsDiagnosisStagingFAB ClassificationWHO ClassificationTreatmentSurvival
Table of ContentsView All
View All
Table of Contents
Disease Characteristics
Early Signs and Symptoms
Later Stage Symptoms
Causes and Risk Factors
Diagnosis
Staging
FAB Classification
WHO Classification
Treatment
Survival
Acute myeloid leukemia (AML) is a type of cancer that starts initially in thebone marrowwhere blood cells are produced and then moves quickly to the blood cells themselves. From there, the cancer can spread to other parts of the body including the liver, spleen, skin, brain, and spinal cord.
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In the United States, nearly 20,000 cases of AML are diagnosed annually, most of them in adults. Around 12,000 people die of AML each year.
Unlike otherforms of leukemia, which tend to strike the young, AML typically affects adults over 65. Among this age group, the five-year survival rate is relatively poor, hovering at around 5%. Cure rates among younger adults tend to be better, with anywhere from 25% to 70% achieving completeremissionfollowing chemotherapy.
Leukemiais a diverse group of cancers that affect both blood-forming tissues and the blood cells themselves. While the disease mostly affectswhite blood cells, some forms of the disease attack other cell types.
In the case of AML, the term “acute” is used because the cancer is rapidly progressing, while “myeloid” refers to both bone marrow and the specific types of blood cells that bone marrow creates.
AML develops in an immature blood cell known as a myeloblast. These are the cells that, under normal circumstances, would mature into fully formed white blood cells such asgranulocytesormonocytes. However, with AML, the myeloblasts will effectively be “frozen” in their immature state but continue to multiply unchecked.
Unlike normal cells that have a specific lifespan, cancer cells are essentially “immortal” and will continue to replicate without end.
With AML, the cancerous blood cells will eventually crowd out the normal ones and even interfere with the development of new white blood cells, red blood cells (erythrocytes), and platelets (thrombocytes).
AML is unlike its cousinacute lymphocytic leukemia (ALL)which affects another type of white blood cell known as alymphocyte. While AML primarily affects older adults, ALL mainly strikes children between the ages of two and five.
The depletion of any of these cells can lead to a cascade ofsymptoms, often non-specific and hard to diagnose. Examples include:
As the disease progresses, other, more telling symptoms may begin to develop. Because leukemia cells are larger than normal white blood cells, they are more likely to get stuck in the smaller vessels of the circulatory system or to collect various organs of the body.
Depending on where the blockage occurs, a person may experience:
Less commonly, AML can affect the kidneys, lymph nodes, eyes, or testicles.
There are a number ofrisk factorsassociated with AML. However, having one or even several of these factors doesn’t mean that you will get leukemia. To date, we still don’t fully understand why some cells will suddenly turn cancerous while others don’t.
There are a number of risk factors associated with this:
For reasons unknown, men are 67% more likely to get AML than women.
If AML is suspected, thediagnosiswill usually begin with a physical exam and a review the person’s medical and family history. During the exam, the doctor will pay close attention to signs like extensive bruising, bleeding, infection, or any abnormality of the eyes, mouth, liver, spleen, or lymph nodes. Acomplete blood count (CBC)will also be performed to identify any abnormalities in the blood composition.
Based on these findings, the doctor may order a number of tests to confirm the diagnosis. These may include:
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Cancer staging is performed to determine the extent to which a cancer has spread. This, in turn, helps the doctor determine the appropriate course oftreatmentso that the person is neither undertreated nor overtreated. The staging also helps predict how long a person is likely to survive following treatment.
Because AML does not involve the formation of a malignant tumor seen in other types of cancer, it cannot be staged with the classicTNM (tumor/lymph node/malignancy) methodology.
There are two different methodologies currently used to stage AML: the French-American-British (FAB) classification of AML and the World Health Organization (WHO) classification of AML.
The French-American-British (FAB) classification was developed in the 1970s and stages the disease based on the type and maturity of the affected cell.
The rationale for the staging is simple: AML will typically follow a pattern wherein immature myeloblasts are the first cells to be affected. As the disease progresses, it will begin to affect myeloblasts in later stages of maturation and then progress to mature white blood cells (such as monocytes and eosinophils) before moving to red blood cells (erythrocytes) and finally megakaryoblasts (immature platelet cells).
This progression will provide the pathologist the information needed to know how advanced the cancer is.
FAB staging ranges from M0 (for early AML) to M7 (for advanced AML) as follows:
The World Health Organization developed a new means of classifying AML in 2008. Unlike the FAB system, the WHO classification takes into account the specific chromosomal mutations found during a cytogenetic analysis. It also factors in the medical conditions that may improve or worsen the outlook (prognosis) of the affected individual.
The WHO system is far more dynamic in its assessment of the disease and can be broadly broken down as follows:
Typically speaking, treatment will begin with chemotherapy. This may include older generation drugs that are can affect both cancerous and noncancerous cells and newer generation targeted drugs that zero in on the cancer cells alone.
With that being said, a small number of leukemia cells will likely remain following chemotherapy, leading to relapse in the majority of cases. To avoid this, doctors will prescribe ongoing therapy based on the person’s post-treatment results and health status.
In persons with good diagnostic indicators, treatment may only involve three to five courses of intensive chemotherapy, referred to as consolidated chemotherapy. The IDH1 inhibitor Tibsovo (ivosidenib tablets) may be recommended in combination with other treatments for people 75 and older with other conditions that rule out the use of intensive induction chemotherapy, or those withrelapsed or refractory AML.
For those at high risk of relapse, other, more aggressive treatments may be required including astem cell transplantif a donor can be found. Less commonly, surgery or radiation therapy may be recommended.
Because AML chemotherapy tends to have lead to severe immune suppression, elderly patients may not able to tolerate treatment and may instead be given less intensive chemo orpalliative care.
The outlook for a personwho has undergone AML treatment can vary significantly based on the stage of cancer at the time of the diagnosis. But, there are other factors that can also predict the likely outcome. Among them:
Overall, the average cure rate of AML is between 20% and 45%. Sustained remission rates tend to be highest in younger people who are more able to tolerate treatment.
A Word From Verywell
If you have been diagnosed with AML, you will be faced with emotional and physical challenges that may be hard to overcome. Don’t go it alone. Your chances of successfullycopingwill be far improved if you build a support network made up of loved ones, healthcare professionals, and others who have eithergone through or are going throughcancer treatment.
Even after you have undergone treatment, fears about relapse may linger for months or even years. With support, you will eventually overcome these concerns and learn to monitor your health with regular doctor visits. Generally speaking, if relapse hasn’t occurred within a few years, it is unlikely that AML will ever return.
While there is nothing that you can take to prevent a relapse, a healthy lifestyle can greatly improve your odds. This includes imparting good eating habits, exercising regularly, stopping smoking, and getting plenty of rest to avoid stress and fatigue.
In the end, it is important to take things one day at a time and to have someone you can turn to if ever you need support.
3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Cancer Society.What Is Acute Myeloid Leukemia (AML)?Updated August 21, 2018.American Cancer Society.Key statistics for acute myeloid leukemia (AML).Servier Pharmaceuticals LLC.Tibsovo (ivosidenib tablets).Additional ReadingAmerican Cancer Society. “Survival Statisticsfor Myelodysplastic Syndromes.” Washington, D.C.; updated January 22, 2018.De Kouchenovsky, I. and Abdul Hay, M. “Acute myeloid leukemia: a comprehensive review and 2016 update.“Blood Can J.2016; 6;e441.Döhner, H.; Weisdorf, D.; and Bloomfield, C. “Acute Myeloid Leukemia.“New Engl J Med. 2015; 373(12): 1136-52. DOI:10.1056/NEJMra1406184.
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Cancer Society.What Is Acute Myeloid Leukemia (AML)?Updated August 21, 2018.American Cancer Society.Key statistics for acute myeloid leukemia (AML).Servier Pharmaceuticals LLC.Tibsovo (ivosidenib tablets).Additional ReadingAmerican Cancer Society. “Survival Statisticsfor Myelodysplastic Syndromes.” Washington, D.C.; updated January 22, 2018.De Kouchenovsky, I. and Abdul Hay, M. “Acute myeloid leukemia: a comprehensive review and 2016 update.“Blood Can J.2016; 6;e441.Döhner, H.; Weisdorf, D.; and Bloomfield, C. “Acute Myeloid Leukemia.“New Engl J Med. 2015; 373(12): 1136-52. DOI:10.1056/NEJMra1406184.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Cancer Society.What Is Acute Myeloid Leukemia (AML)?Updated August 21, 2018.American Cancer Society.Key statistics for acute myeloid leukemia (AML).Servier Pharmaceuticals LLC.Tibsovo (ivosidenib tablets).
American Cancer Society.What Is Acute Myeloid Leukemia (AML)?Updated August 21, 2018.
American Cancer Society.Key statistics for acute myeloid leukemia (AML).
Servier Pharmaceuticals LLC.Tibsovo (ivosidenib tablets).
American Cancer Society. “Survival Statisticsfor Myelodysplastic Syndromes.” Washington, D.C.; updated January 22, 2018.De Kouchenovsky, I. and Abdul Hay, M. “Acute myeloid leukemia: a comprehensive review and 2016 update.“Blood Can J.2016; 6;e441.Döhner, H.; Weisdorf, D.; and Bloomfield, C. “Acute Myeloid Leukemia.“New Engl J Med. 2015; 373(12): 1136-52. DOI:10.1056/NEJMra1406184.
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