Acute myeloid leukemia (AML) is an aggressive type of cancer that starts in the blood and blood-forming tissues of the body. It primarily impacts people over the age of 65.
About acute myeloid leukemia (AML)
Acute myeloid leukemia affects myeloid stem cells, which produce red blood cells, platelets and granulocytes, a type of white blood cell.
It occurs when a myeloid stem cell becomes cancerous. In these cases, the myeloid stem cells produce diseased cells that do not perform their job well. They also multiply rapidly. As the disease progresses, the abnormal cells can crowd out healthy cells.
As a result, AML may cause patients to develop anemia or have a poor ability to clot blood. It can severely weaken the patient¡¯s immune system, leading to frequent infections.
There are several subtypes of AML. Many depend on different chromosome abnormalities of the cancer cells and the types of molecules these cells produce. These specific subtypes can impact a patient¡¯s treatment plan and outlook.
More than 20,000 people are diagnosed with AML in the U.S. each year. It is the most common acute leukemia in adults. While pediatric patients can develop the disease, about 60% of all cases are in people age 65 and older.
As an acute leukemia, AML is aggressive and can be particularly difficult to treat, so patients should begin treatment as soon as possible. AML¡¯s five-year survival rate is about 30%, though that figure differs based on the exact subtype of each person¡¯s cancer and the age of the patient.
Blood cell creation
The body produces millions of blood cells each day. Most develop in the bone marrow, the spongy interior of bones that contains immature stem cells.?
In a healthy person, these immature stem cells first become either lymphoid stem cells or myeloid stem cells.
Lymphoid stem cells develop into white blood cells, which are immune system cells. They start by becoming immature white blood cells known as lymphoblasts, then mature into lymphocytes. The two types of lymphocytes that are usually involved in leukemia are B cells and T cells. B cells produce the antibodies responsible for attacking bacteria and viruses that invade the body. T cells help alert other immune cells to the presence of infection or fight infection directly.
Myeloid stem cells also develop into white blood cells. The myeloid stem cells first become immature white blood cells known as myeloblasts. They then mature into monocytes and granulocytes, including neutrophils, all of which fight disease. Other myeloid stem cells develop into red blood cells, which carry oxygen throughout the body; and platelets, which help the blood clot.
Leukemia occurs when the DNA (the genetic instructions that control cell activity) of a bone marrow stem cell mutates at some point in its development. The cell becomes cancerous, begins multiplying rapidly and crowds out healthy cells in the blood and bone marrow. These diseased cells can also gather in specific parts of the body, including the liver, lymph nodes, spleen and skin.
How is leukemia classified?
While there are many types of leukemia, they are typically classified by the type of stem cell that has turned cancerous, either lymphoid or myeloid.
Many types are also classified as either chronic or acute. Acute leukemia?impacts immature cells, preventing them from developing and carrying out their function. These cells tend to multiply rapidly, making acute leukemia more aggressive.?
Chronic leukemia?involves mature or partially mature cells. These cells multiply more slowly and are less aggressive, making chronic leukemia less aggressive than acute leukemia.
Risk factors
A risk factor is anything that increases the chance of developing a disease. Knowing a disease¡¯s risk factors can be an important step towards catching it early. It's important to note that not everyone with risk factors will develop the disease.
Risk factors for acute myeloid leukemia (AML) include:
- Smoking
- Age: About 60% of all cases are in patients age 65 and older.
- Sex: More males develop AML than females.
- Past treatment with chemotherapy or radiation therapy for a previous cancer. While this these therapies can cause AML, their benefits as cancer treatments far outweigh their risks.
- Myeloproliferative neoplasms (MPNs): MPNs are chronic cancers of the bone marrow and blood. While they are not classified as leukemia, MPNs (especially myelofibrosis) can transform to acute myeloid leukemia. MPNs are treated in the Leukemia Center by our experts at the Clinical Research Center for Myeloproliferative Neoplasms. Learn more about MPNs.
- Myelodysplastic syndrome (MDS): In MDS, the bone marrow does not produce enough healthy blood cells. MDS evolves into AML in 10-20% of patients. Learn more about myelodysplastic syndrome. Learn more about MDS.
- Genetic disorders: Individuals with certain genetic disorders are at a higher risk of developing AML. These include Down syndrome, Fanconi anemia, and hereditary cancer syndromes such as Li-Fraumeni syndrome. Learn more about hereditary cancer syndromes.
- Chemical exposure: Long-term exposure to benzene, a chemical used in the petroleum industry, can cause AML.
- Family History: People with a parent, sibling or child who has had AML may be more likely to develop the disease.
Some cases of leukemia can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Learn more about acute myeloid leukemia:
Learn more about clinical trials for acute myeloid leukemia.
Blood cell creation (click to enlarge).
Acute myeloid leukemia: What to know
Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. ¡°Acute¡± means that this leukemia can progress rapidly if not treated, and ¡°myeloid¡± refers to the type of cell this leukemia starts from.
While AML typically occurs in adults with median age of 67, MD Anderson does treat many adolescent and young adult AML patients.?
If you or a loved one has been diagnosed with AML, you have many questions. We spoke with to get answers to some common questions he hears about AML.
What is leukemia?
Leukemia is the name for a very large, complex, diverse group of malignant tumors that arise from the bone marrow and involve the blood.?
Can you explain the different types of leukemia??
Leukemias are grouped by the type of cell affected and the rate of cell growth.
Acute leukemia involves an overgrowth of very immature blood cells. There are two main types of?acute leukemia:
- Acute lymphocyte leukemia (ALL)
- Acute myeloid (or myelogenous) leukemia (AML)
Chronic leukemia involves an overgrowth of mature blood cells. The main types of chronic leukemia are:
- Chronic lymphoblastic leukemia (CLL)
- Chronic myeloid (or myelogenous) leukemia (CML)?
We also treat many patients with other subtypes of leukemia, such as myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN), aplastic anemia, blastic plasmacytoid dendritic cell neoplasm (BPDCN) and hairy cell leukemia.?
What are the symptoms of AML??
There is generally a wide range of symptoms and presentations. Some patients may not have many symptoms and may only be diagnosed through blood testing when presenting in the clinic, through the emergency room, or in the hospital.
Others may experience common symptoms, such as fatigue, fevers/infections, bleeding and easy bruising. Some patients may be so ill that they present directly through the emergency room to the intensive care unit.
Are some people more likely to develop AML?
The exact cause of AML is unknown.?Some associations/risk factors include:
- Exposure to ionizing radiation or specific chemical exposure
- Certain genetic/familial syndromes, such as familial platelet disorders with propensity to myeloid malignancies or inherited bone marrow failure syndromes
- Prior cancer treatment with either radiation or chemotherapy
- Patients with antecedent hematologic malignancy, such as MDS, MPN, aplastic anemia, BPDCN
How is AML typically treated?
Unfortunately, there¡¯s not yet a reliable, standard therapy for most patients with AML. Many patients undergo chemotherapy and/or a stem cell transplant, which is a procedure that replaces defective or damaged cells in patients whose normal blood cells have been affected by cancer.
But stem cell transplants often aren¡¯t an option for patients older than age 70, and some of the most common intensive chemotherapy regimens used for patients at younger ages may not work for all older patients. Often the best options may include a clinical trial.?
What clinical trials is MD Anderson offering for older AML patients?
At MD Anderson, we have a number of different AML clinical trials, some of which are part of our . Some of the frontline AML clinical trials we have for older patients include:
- A hypomethylator agent (such as Azacytidine, Decitabine or SGI-110) alone or with?another agent
- Novel clinical trial drugs alone or in combinations, including targeted therapies based on a particular patient¡¯s mutational profile (FLT3, IDH 1 or 2, or CD123, for example)
- Immunotherapy agents or immunotherapy in combination with chemotherapy
What other new research is on the horizon for AML??
Besides the clinical trials I just mentioned, we¡¯ll soon be looking at targeted therapy agents aimed at a particular molecular mutation or aberrant molecular pathways
Other approaches will soon include newer forms of immunotherapy, such as chimeric antigen receptor (CAR) T-cell therapy, bi-specific antibody therapies and others via upcoming clinical trials.
Why are patients with acute leukemia at increased risk of infection??
If the white blood cell count, specifically the neutrophil count, is very low, this can weaken the immune system¡¯s functioning and make it harder for a patient to fight off infections.
This can happen because of the leukemia itself or as a result of the cancer treatment. Generally, patients in active therapy may be placed on preventive antibiotics to help protect against some of the more common infections.
What¡¯s your advice for newly diagnosed AML patients??
Every patient is unique and each patient should have a serious conversation with their oncologist when diagnosed with AML. It¡¯s important that you receive treatment from someone with a lot of experience treating AML and who has access to the latest clinical trials. I encourage new AML patients to schedule an appointment with an experienced hematologist at a comprehensive cancer center such as?MD Anderson.
I also recommend finding out about your clinical trial options upfront, whether you have a new AML diagnosis or you have relapsed AML.
Acute myeloid leukemia: From diagnosis to stem cell transplant to survivor
Three years ago, I started having chest pains. But I wouldn't go to the doctor for fear of being admitted and missing an upcoming trip to my grandson's baptism. ?
When the pain got so bad that I was screaming during the night, my wife finally forced me to see a doctor. ?
Initially, the doctor said it was pneumonia. But my high white blood cell count and enlarged spleen led him to change his diagnosis: leukemia. ?
He sent my wife and me to the local hospital, where another look at my lung showed fluid in my right pleural sack. ?
Three weeks later, I got a definitive diagnosis -- acute myeloid leukemia (AML). I told my doctor I wanted to go to MD Anderson.?
My clinical trial for acute myeloid leukemia
Arriving at MD Anderson felt like the first day of school. The hospital was huge, and I started wondering if I had made the right choice.?
My doctor, Farhad Ravandi-Kashani,M.D., helped ease my mind. He confirmed my AML diagnosis and started me on a clinical trial in late July 2010.?
The trial required me to spend 30 days in a protective environment, where I received a chemotherapy treatment of Clofarabine, Idarubicin and Cytarabine. ?
No one except medical professionals was allowed in the room. I could only see visitors through a window and talk to them by phone.
The exceptions were the dining people and my spiritual help -- a Eucharistic minister who brought me communion almost every day. This gave me great comfort.?
But in late August, I got bad news: My blast count (the cancer cells in AML) had gone up. ?
I was devastated. I told my doctor that if I was going to die, I wanted to go home. ?
He just chuckled and said they still had lots to try.
Preparing for my stem cell transplant
I started chemotherapy again. Dr. Ravandi-Kashani wanted to get me into remission so I could undergo a stem cell transplant. ?
The chemo did get me into remission, but my counts wouldn't recover. I had transfusions every other day.
Meanwhile, MD Anderson found that my brother was a good match for my stem cell transplant.?
A transplant sounded scary. I was afraid I would die. I didn't feel any better knowing that the success rates for stem cell transplants were similar to those of my failed clinical trial. ?
But my wife pushed me forward, even taking my local oncologist to task when he said I could wait and see if the leukemia came back.
Pushing through my stem cell transplant
The chemotherapy during my stem cell transplant was vicious. It started like the other rounds, but after a couple of weeks, I had lost my hair and even my mustache fell out. Large blisters developed on the bottom of my tongue and down my esophagus. Every swallow was painful. ?
But I pushed through it. I spent every day before and after the transplant walkingthe ward. This stay was a relief compared to my time in the protective environment. ?
Going home after my stem cell transplant
On Thanksgiving Day -- 17 days after my stem cell transplant -- I was discharged. My counts were still low, but life was waiting. My entire family gathered in my son's apartment, where we celebrated Thanksgiving together for the first time in years. ?
Getting out of the hospital had given me a reason to give thanks. Eating dinner with my five children and three grandkids brought great joy -- not just to me, but to my family who, just six months earlier, had learned they might lose their dad. ?
Two months later, my counts had recovered enough for me to return home to El Paso. I surprised my wife and youngest daughter by arriving a day early. Record cold temperatures meant the schools were closed for four days, so I got to spend my first week home with my youngest daughter and wife, who's a teacher like me.
Celebrating life after AML
It's been two-and-half years now since my stem cell transplant. My counts are almost normal, and I'm 100% engrafted. ?
Since my transplant, I've seen the births of three grandchildren. I've watched my son Chris graduate from medical school, my daughter Emily graduate from college, my daughter Kaela graduate from high school and my son Tony get married. And I've spent many mornings enjoying coffee with my wife. ?
I was even honored as teacher of the year my first year back at work after my diagnosis. ?
During my diagnosis and treatment, I spent a lot of time breaking down in tears. I still tear up, but now they're tears of joy as I consider how fortunate I have been.
Leukemia survivor finds second chance ¡ª and third wife ¡ª at MD Anderson
Two-time widower Paul Nielsen was in excellent health at age 67. So the former marathon runner knew something was wrong when he started feeling tired all the time in the fall of 2015.
¡°I had to nap for a couple of hours almost every afternoon,¡± he says. ¡°I couldn¡¯t even make it to supper.¡±
Though concerned by his fatigue, Paul put off investigating it until his regular annual physical in January 2016. That¡¯s when blood tests revealed he had acute myeloid leukemia (AML), a type of blood cancer.
¡°I wasn¡¯t really shocked,¡± he says. ¡°We were looking for something and that was it, so we just needed to get on it.¡±
Finding the right leukemia treatment
Paul¡¯s local doctor didn¡¯t treat leukemia, so he got a referral to MD Anderson. It was here that Paul met ¡ª and found his future wife.
Ciurea confirmed Paul¡¯s acute myeloid leukemia diagnosis, then recommended a mild form of chemotherapy. It was not as effective as they¡¯d hoped, so Ciurea switched Paul to a more aggressive form of chemotherapy. Paul received five rounds of it, followed by an allogeneic stem cell transplant.
¡®We¡¯re supposed to be together¡¯
The woman who would eventually become Paul¡¯s third wife was already a professional friend of his in the oil and gas industry. He¡¯d actually known Cyndi ¨C whose husband had died suddenly just a few months earlier ¨C for about 10 or 15 years. ¡°But I think God put us in each other¡¯s lives,¡± Paul says of their connecting through his leukemia treatment.
A mutual friend dragged Cyndi to MD Anderson in June explicitly to pray for Paul¡¯s recovery. Cyndi and Paul kept running into each other at group lunches and benefit functions, and began dating in February 2017. The couple became exclusive in March 2017, and tied the knot on a Florida beach on June 30, Cyndi¡¯s birthday.
¡°I had no hair when we started courting, but Cyndi said she didn¡¯t care,¡± Paul recalls. ¡°She said I looked handsome with or without it. So I think we¡¯re supposed to be together.¡±
¡®My life didn¡¯t stop because of leukemia¡¯
Paul is also convinced that God led him to MD Anderson.
¡°My wife and I are people of faith, and we believe physical and spiritual healing go hand in hand,¡± Paul says. ¡°MD Anderson is that kind of place. First of all, it is the No. 1 cancer center in the world. This is the place in the universe to be if you have cancer. But it¡¯s also special. It¡¯s personalized care, research and treatment, all in one. It¡¯s not like going to a governmental bureaucracy, where you¡¯re just a number.¡±
Side effects didn¡¯t slow him down
Aside from hair loss, Paul suffered a number of other side effects during treatment, including insomnia and nausea so severe that he dropped 30 pounds. But his stem cell transplant on Nov. 23, 2016, was a success, and today, more than a year later, he shows no evidence of disease.
Paul often shares his story with others, including patients at MD Anderson, to inspire them and offer them hope in their own trials in life.
¡°I still get tired sometimes, but nothing like before,¡± says the newlywed. ¡°And I¡¯m not sick or limited today at all, though I am still recovering. My life didn¡¯t stop because of leukemia. It didn¡¯t even slow down.¡±
or by calling 1-877-632-6789.
Why choose MD Anderson for acute myeloid leukemia treatment?
Choosing the right cancer center may be the most important decision you can make as a leukemia patient. At MD Anderson¡¯s Leukemia Center and Stem Cell Transplantation and Cellular Therapy Center, you¡¯ll get treatment from one of nation¡¯s the largest, most experienced leukemia teams at a top-ranked cancer center.
Using a comprehensive team approach, we work together to give you customized care that includes the most advanced diagnostic methods and treatments. These include clinical trials of new drugs and drug combinations. We offer clinical trials for all situations ¨C from patients receiving their first treatment, to patients who have exhausted all standard treatment options.
As a leading center for leukemia care, we offer access to innovative new therapies and clinical trials that may help increase your chances for successful treatment. Many of these were developed by our own researchers.
Treatment designed specifically for you
Successful leukemia treatment begins with?accurate?and precise diagnosis. Many of our leukemia patients have been misdiagnosed before they come to?MD Anderson. We have the expertise and experience gained from being one of the most active programs in the world, and our specialized pathologists are highly skilled in diagnosing leukemia.
Our approach to leukemia is customized especially for you. We carefully evaluate your risk factors and the specific characteristics of your leukemia to determine if immediate treatment is necessary. If it is, we recommend the most effective therapies while aiming to limit treatment side effects.
Whether you are treated as an inpatient or outpatient, our comprehensive program offers all the services needed to care for leukemia and respond to its impact on your?body. We aim to accomplish as much care as possible on an outpatient basis. If hospitalization is needed, our expert staff is specially trained to care for patients at every phase of the treatment journey.
MD Anderson is my hope. I know that without it, I wouldn¡¯t be alive today.
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