Adult acute myeloid leukemia (AML) is a disease in which cancer
(malignant) cells are found in the blood and bone marrow. AML is
also called acute nonlymphocytic leukemia or ANLL. The bone marrow
is the spongy tissue inside the large bones in the body. The bone
red blood cells (which carry oxygen and other materials to all
tissues of the body)
white blood cells (which fight infection)
platelets (which make the blood clot)
Normally, the bone marrow makes cells called blasts that develop
(mature) into several different types of blood cells. Each have
specific jobs to do in the body. AML affects the blasts that are
developing into white blood cells called granulocytes.
In AML, the blasts do not mature and become too numerous. These
immature blast cells are then found in the blood and the bone
marrow. Leukemia can be acute (progressing quickly with many
immature blasts) or chronic (progressing slowly with more mature
looking cancer cells). Acute myeloid leukemia progresses quickly.
AML can occur in adults or children.
AML is often difficult to diagnose. The early signs may be
similar to the flu or other common diseases. A doctor should be
seen if the following signs or symptoms won't go away:
Achiness in the bones or joints
If there are symptoms, a doctor may order blood tests to count
the number of each of the different kinds of blood cells. If the
results of the blood tests are not normal, a doctor may do a
bone marrow biopsy
. During this test, a needle is inserted
into a bone and a small amount of bone marrow is taken out and
looked at under a microscope. A doctor can then tell what kind of
leukemia is present and plan the best treatment. The chance of
recovery (prognosis) depends on the type of AML and the patient's
age and general health.
Stages of adult acute myeloid leukemia
There is no staging for AML. The choice of treatment depends on
whether the patient has been treated.
Untreated AML means no treatment has been given except to treat
symptoms. There are too many white blood cells in the blood and
bone marrow, and there may be other signs and symptoms of leukemia.
Rarely, tumor cells can appear as a solid tumor called an isolated
granulocytic sarcoma or chloroma.
Treatment has been given, and the number of white blood cells
and other blood cells in the blood and bone marrow is normal. There
are no signs or symptoms of leukemia.
Recurrent disease means the leukemia has come back after going
into remission. Refractory disease means the leukemia has not gone
into remission following treatment.
There are treatments for all patients with AML. The primary
treatment of AML is chemotherapy. Radiation therapy may be used in
certain cases. Bone marrow transplantation and biological therapy
are being studied in clinical trials.
Chemotherapy is the use of drugs to kill cancer cells. Drugs
may be given by mouth, or they may be put into the body by a needle
in a vein or muscle. Chemotherapy is called a systemic treatment
because the drug enters the bloodstream, travels through the body,
and can kill cancer cells throughout the body. Chemotherapy may
sometimes be put into the fluid that surrounds the brain through a
needle in the brain or back (intrathecal chemotherapy).
Radiation therapy uses x-rays or other high-energy rays to
kill cancer cells and shrink tumors. Radiation for AML usually
comes from a machine outside the body (external radiation therapy).
If the leukemia cells have spread to the brain, radiation therapy
to the brain or intrathecal chemotherapy will be given. There are
two phases of treatment for AML. The first stage is called
. The purpose of induction therapy is to
kill as many of the leukemia cells as possible and make patients go
Once in remission with no signs of leukemia, patients enter a
second phase of treatment (called
which tries to kill any remaining leukemia cells. Chemotherapy may
be given for several years to keep a patient in remission.
Bone marrow transplantation
Bone marrow transplantation is used to replace the bone marrow
with healthy bone marrow. First, all of the bone marrow in the body
is destroyed with high doses of chemotherapy with or without
radiation therapy. Healthy marrow is then taken from another person
(a donor) whose tissue is the same as or almost the same as the
patient's. The donor may be a twin (the best match), a brother or
sister, or a person who is not related. The healthy marrow from the
donor is given to the patient through a needle in the vein, and the
marrow replaces the marrow that was destroyed. A bone marrow
transplant using marrow from a relative or from a person who is not
related is called an
allogeneic bone marrow
Autologous bone marrow transplant
Another type of bone marrow transplant, called autologous bone
marrow transplant, is being studied in clinical trials. To do this
type of transplant, bone marrow is taken from the patient and
treated with drugs to kill any cancer cells. The marrow is then
frozen to save it. Next, high-dose chemotherapy is given with or
without radiation therapy to destroy all of the remaining marrow.
The frozen marrow that was saved is then thawed and given to the
patient through a needle in a vein to replace the marrow that was
Peripheral blood stem cell transplant
Another type of autologous transplant is called a peripheral
blood stem cell transplant. The patient's blood is passed through a
machine that removes the stem cells (immature cells from which all
blood cells develop), then returns the blood to the patient. This
procedure is called leukapheresis and usually takes three or four
hours to complete. The stem cells are treated with drugs to kill
any cancer cells and then frozen until they are transplanted to the
patient. This procedure may be done alone or with an autologous
bone marrow transplant. A greater chance for recovery occurs if the
doctor chooses a hospital that does more than five bone marrow
transplantations per year.
Biological therapy tries to get the body to fight cancer. It
uses materials made by the patient's body or made in a laboratory
to boost, direct, or restore the body's natural defenses against
disease. Biological therapy is sometimes called biological response
modifier therapy or immunotherapy.
Treatment by stage
Treatment for adult AML depends on the type of AML, the
patient's age and overall health. Standard treatment may be
considered based on its effectiveness in past studies, or
participation in a clinical trial may be considered. Not all
patients are cured with standard therapy, and some standard
treatments may have more side effects than are desired. For these
reasons, clinical trials are designed to find better ways to treat
cancer patients and are based on the most up-to-date information.
Clinical trials are ongoing in most parts of the country for most
stages of adult AML. For more information, call the Cancer
Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at
Untreated adult acute myeloid leukemia
Treatment will probably be systemic chemotherapy. If leukemia
cells are found in the brain, chemotherapy will be injected
directly into the spinal cord (intrathecal). Clinical trials are
testing new drugs.
Adult acute myeloid leukemia in remission
Treatment will most likely be:
A clinical trial evaluating new chemotherapy
Drugs and new ways of giving drugs
A clinical trial evaluating bone marrow or peripheral stem cell
Recurrent adult acute myeloid leukemia
Radiation therapy may be given to reduce symptoms. Patients may
also choose to take part in clinical trials of new chemotherapy
drugs or bone marrow transplantation.
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