What is AML?1,2
Acute myeloid leukaemia (AML) is a type of blood cancer that develops rapidly. It usually originates in the bone marrow, where new blood cells are produced, but can quickly spread to the blood and other parts of the body. AML interferes with the production of blood cells by upscaling the production of only partially-developed white blood cells and preventing normal blood cell production. Since the white blood cells are not fully developed, they are unable to function properly, which can severely weaken the immune system.
What causes AML?1,3,4
Acute myeloid leukaemia is usually attributed to genetic mutations that overproduce abnormal white blood cells that are not fully developed. These mutations are rarely passed on from parent to child. Often, mutations are acquired by being exposed to certain chemicals or due to errors in DNA replication when our bodies grow.
Certain risk factors may make someone more likely to develop AML:
- Being male
- Increased age
- Previous chemotherapy or radiotherapy treatment
- Certain blood disorders
- Some genetic disorders
There are several different AML-causing mutations, and these can have varying effects on the severity of the disease. The FLT3 gene is a common site for mutations and in 25–30% of patients is associated with a poor prognosis, depending on the type of mutation.
What are the symptoms of AML?5,6
Symptoms of AML are associated with a compromised immune system and usually develop over a few weeks. As time goes on and the number of abnormal white blood cells increases, symptoms may become more severe.
- Looking pale or ‘washed out’
- Weight loss
- Recurrent infections that are difficult to shake off
- Unusual and frequent bleeding, such as bleeding gums or nosebleeds
- Easily bruised skin
- Flat red or purple spots on the skin
- Bone and joint pain
- A feeling of fullness or discomfort in the tummy
- Swollen glands in the neck, armpit or groin that may be sore when touched
How is AML diagnosed?7
AML is usually diagnosed by a haematologist after various tests:
- Blood tests will be used to determine if there are lots of abnormal white blood cells, which may indicate leukaemia
- A bone marrow biopsy is used to confirm an AML diagnosis
- Other tests such as genetic testing may also be used to determine which mutation is present and to give a prognosis
- Additional imaging tests may also be done to check how far the cancer has spread
What is the goal of treatment for AML?8,9
AML develops very rapidly, so treatment is usually initiated within a few days of an AML diagnosis. The goal of treatment is to cure the disease, usually with intense chemotherapy to kill the cancer cells. Some patients may be better suited to a less intensive chemotherapy treatment. Other, more targeted, therapies may be used in conjunction with chemotherapy depending on the subtype of AML and the genetic mutation. If chemotherapy is unsuccessful, other therapies, such as radiotherapy or a bone marrow transplant, may be used instead.
Once patients reach remission, when no cancer cells are detected in the body, they may be given a few more cycles of chemotherapy, known as consolidation therapy, to prevent the cancer coming back.
- National Cancer Institute. Adult Acute Myeloid Leukemia Treatment. Available at:https://www.cancer.gov/types/leukemia/patient/adult-aml-treatment-pdq. Last accessed May 2020.
- American Cancer Society. About Acute Myeloid Leukemia. Available at: https://www.cancer.org/cancer/acute-myeloid-leukemia/about/what-is-aml.html. Last accessed May 2020.
- NHS Acute Myeloid Leukaemia. Causes. Available at: https://www.nhs.uk/conditions/acute-myeloid-leukaemia/causes/. Last accessed May 2020.
- Patel JP, et al. Prognostic relevance of integrated genetic profiling in acute myeloid leukemia. N Engl J Med. 2012;366:1079–1089.
- NHS Acute Myeloid Leukaemia. Symptoms. Available at: https://www.nhs.uk/conditions/acute-myeloid-leukaemia/symptoms/. Last accessed May 2020.
- Leukemia and Lymphoma Society. Acute myeloid leukemia: signs and symptoms. Available at: https://www.lls.org/leukemia/acute-myeloid-leukemia/signs-and-symptoms. Last accessed May 2020.
- NHS Acute myeloid leukaemia. Diagnosis. Available at: https://www.nhs.uk/conditions/acute-myeloid-leukaemia/diagnosis/. Last accessed May 2020.
- NHS Acute myeloid leukaemia. Treatment. Available at: https://www.nhs.uk/conditions/acute-myeloid-leukaemia/treatment/. Last accessed May 2020.
- Leukemia and Lymphoma Society. About Acute Myeloid Leukemia. Treatment. Available at: https://www.lls.org/leukemia/acute-myeloid-leukemia/treatment. Last accessed May 2020.