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Acute myeloid leukaemia

Acute myeloid leukaemia (AML) is an aggressive cancer of the myeloid cells.

Leukaemia is cancer of the white blood cells. Acute leukaemia means the condition progresses rapidly and aggressively, requiring immediate treatment.

Acute leukaemia is classified according to the type of white blood cells that are affected. There are two main types:

  • lymphocytes  mostly used to fight viral infections
  • myeloid cells  which perform a number of different functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage 

These pages focus on acute myeloid leukaemia (AML), which is an aggressive cancer of the myeloid cells. The following types of leukaemia are covered separately:

Signs and symptoms of acute myeloid leukaemia

The symptoms of AML usually develop over a few weeks, and become increasingly more severe. Symptoms can include:

  • pale skin
  • tiredness
  • breathlessness
  • frequent infections
  • unusual and frequent bleeding, such as bleeding gums or nosebleeds

In more advanced cases, AML can make you extremely vulnerable to life-threatening infections or serious internal bleeding.

Read more about the symptoms of AML and complications of AML.

Seeking medical advice

You should see your GP if you or your child have possible symptoms of AML. Although it is highly unlikely that leukaemia is the cause, these symptoms should be investigated.

If your GP thinks you may have leukaemia, they will arrange for blood tests to check your white blood cells. If this test suggests there is a problem, you will be urgently referred to a haematologist (a specialist in treating blood conditions) for further tests and any necessary treatment.

Read more about diagnosing AML.

What causes acute myeloid leukaemia?

AML occurs when specialised cells called stem cells, which are found in the bone marrow (a spongy material inside the bones), produce excessive numbers of immature white blood cells. These immature cells are known as blast cells.

Blast cells don't have the infection-fighting properties of healthy white blood cells, and their excessive production can lead to a decrease in the number of red blood cells (which carry oxygen in the blood) and platelets (cells that help the blood to clot).

It is not clear exactly why this happens, although a number of factors that can increase your risk of developing AML have been identified. These include:

  • exposure to very high levels of radiation, including previous treatment with radiotherapy
  • exposure to benzene  a chemical used in manufacturing that is also found in cigarette smoke
  • having an underlying blood disorder or genetic condition (such as Down's syndrome)

Read more about the causes of AML.

Who is affected

AML is an uncommon type of cancer. Around 2,600 people are diagnosed with the condition each year in the UK.

AML can develop at any age, but it's more common in people over the age of 60.

How acute myeloid leukaemia is treated

AML is an aggressive type of cancer that can develop rapidly, so treatment usually needs to begin soon after a diagnosis is confirmed.

The main treatment for AML is chemotherapy, which is used to kill as many leukaemia cells in your body as possible and reduce the risk of the condition coming back (relapsing).

In some cases, intensive chemotherapy and radiotherapy may be needed, in combination with a bone marrow or stem cell transplant, to achieve a cure.

Read more about treating AML.

Outlook

The outlook for AML largely depends on the specific type of AML you have, your age and general health.

There are many subtypes of AML, which are classified according to a number of features – such as the specific genetic changes in the leukaemia cells. Some types of AML are more challenging to treat than others.

Even if treatment is initially successful, there remains a significant risk that the condition will return at some point during the next few years. If this happens, treatment may need to be repeated.

A number of recent medical trials have suggested that almost half of those aged under 60 diagnosed with AML will live for at least five years, and in some types of AML, such as acute promyeloid leukaemia (APML), around 85% will live for at least five years.

In general, the outlook for children with AML tends to be better than that of adults diagnosed with the condition.


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Acute myeloid leukaemia

The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells (blast cells) in your blood increases.

The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells (blast cells) in your blood increases.

Symptoms of AML can include:

  • pale skin
  • tiredness
  • breathlessness
  • a high temperature (fever)
  • excessive sweating
  • weight loss
  • frequent infections
  • unusual and frequent bleeding, such as bleeding gums or nosebleeds
  • easily bruised skin
  • flat red or purple spots on the skin (petechiae)
  • bone and joint pain
  • a feeling of fullness or discomfort in your tummy (abdomen), caused by swelling of the liver or spleen

In rare cases of AML, the affected cells can spread into the central nervous system. This can cause symptoms such as headaches, fits (seizures), vomiting, blurred vision and dizziness.

When to seek medical advice

You should see your GP if you or your child have the symptoms listed above.

Although it is highly unlikely that AML is the cause, any condition that causes these symptoms needs to be promptly investigated and treated.

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Acute myeloid leukaemia

In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have blood tests.

In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have blood tests.

A high number of abnormal white blood cells, or a very low blood count in the test sample, could indicate the presence of leukaemia. If this is the case, you will be urgently referred to a haematologist (a specialist in treating blood conditions).

A haematologist may carry out further blood tests, in addition to some of the tests outlined below.

Bone marrow biopsy

To confirm a diagnosis of AML, the haematologist will take a small sample of your bone marrow to examine under a microscope. This procedure is known as a bone marrow biopsy, which is usually carried out under a local anaesthetic

The haematologist will numb an area of skin at the back of your hip bone, before using a thin needle to remove a sample of liquid bone marrow. In some cases, a larger needle may also be used to remove a small amount of bone and bone marrow together.

The procedure is usually very well tolerated, but may cause some bruising and discomfort for a few days afterwards in a minority of people. The procedure takes around 15 minutes to complete, and you should not have to stay in hospital overnight.

The bone marrow sample will be checked for any cancerous cells. If cancerous cells are present, the biopsy can also determine the type of leukaemia you have.

Further tests

There are additional tests that can be used to help reveal more information about the progress and extent of your AML. They can also provide an insight into how the condition should be treated. These tests are described below.

Genetic testing

Genetic tests can also be carried out on blood and bone marrow samples to identify the genetic makeup of the cancerous cells. There are many specific genetic variations that can occur in AML, and knowing the exact type of AML you have can help doctors decide the most appropriate treatment.

For example, people who have a type of AML known as acute promyelocytic leukaemia (APML) are known to respond well to a medicine called All Trans-Retinoic Acid (ATRA).

Scans

If you have AML, a computerised tomography (CT) scanX-ray or echocardiogram (an ultrasound scan of the heart) may be used to check that your organs, such as your heart and lungs, are healthy.

These tests are carried out because it is important for doctors to assess your general health before they can decide on the most appropriate treatment for you.

Lumbar puncture

In the rare situations where it is believed there is a risk that AML has spread to your nervous system, a lumbar puncture may be carried out. In this procedure, a needle is used to extract a sample of cerebrospinal fluid (which surrounds and protects your spine) from your back, so it can be checked for cancerous cells.

If cancerous cells are found in your nervous system, you may need to have injections of chemotherapy medication directly into your cerebrospinal fluid as part of your treatment.

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Acute myeloid leukaemia

If you have acute myeloid leukaemia (AML), you may experience a number of complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment.

If you have acute myeloid leukaemia (AML), you may experience a number of complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment.

Some of the main complications associated with AML are outlined below.

Weakened immune system

Having a weakened immune system  being immunocompromised  is a common complication of AML.

Even if your blood is restored to normal working order with treatment, many of the medications that are used to treat AML can temporarily weaken your immune system.

This means you are more vulnerable to developing an infection, and any infection could be more serious than usual. Complications arising from infection are the leading cause of death in people with AML.

Therefore, you may be advised to:

  • take regular doses of antibiotics to prevent bacterial infections
  • maintain good personal and dental hygiene
  • avoid contact with anyone who is known to have an infection  even if it is a type of infection that you were previously immune to, such as chickenpox or measles
  • check with your GP to ensure that all of your vaccinations are up to date, although you will not be able to have any vaccine containing "live" viruses or bacteria, such as the shingles vaccine and the MMR vaccine (against measles, mumps and rubella)

You should report any possible symptoms of an infection to your treatment unit immediately, as prompt treatment may be required to prevent complications.

Symptoms of an infection can include:

Bleeding

If you have AML, you will bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive when it does occur.

People with advanced AML are more vulnerable to excessive bleeding inside their body, which is the second most common cause of death in people with the condition.

Serious bleeding can occur:

  • inside the skull (intracranial haemorrhage) – causing symptoms such as a severe headache, stiff neck, vomiting and confusion
  • inside the lungs (pulmonary haemorrhage) – causing symptoms such as coughing up blood, breathing difficulties and a bluish skin tone (cyanosis)
  • inside the stomach (gastrointestinal haemorrhage)  causing symptoms such as vomiting blood and passing stools (faeces) that are very dark or tar-like in colour

All these types of haemorrhage should be regarded as a medical emergency. You should dial 999 immediately and ask for an ambulance if you suspect a haemorrhage is occurring.

Infertility

Many of the treatments that are used to treat acute leukaemia can cause infertility. This is often temporary, but in some cases can be permanent.

People who are particularly at risk of permanent infertility are those who have received high doses of chemotherapy and radiotherapy in preparation for a bone marrow or stem cell transplant.

Your treatment team can give a good estimation regarding the risk of infertility in your specific circumstances.

It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have their sperm samples stored. Similarly, women can have eggs or fertilised embryos stored, which can then be placed back into their womb, following treatment.

However, as AML is an aggressive condition that develops rapidly, there may not always be time to do this before treatment needs to start.

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