Diseases & Conditions

Acute myelogenous leukemia (AML)

Acute myelogenous leukemia (AML) is a cancer of the blood and bone marrow — the spongy tissue inside bones where blood cells are made.

The word "acute" in acute myelogenous leukemia denotes the disease's rapid progression and the fact that it affects immature blood cells, rather than mature ones. It's called myelogenous (MI-uh-loj-uh-nus) leukemia because it affects a group of white blood cells called the myeloid cells, which normally develop into the various types of mature blood cells, such as red blood cells, white blood cells and platelets.

Acute myelogenous leukemia is also known as acute myeloid leukemia, acute myeloblastic leukemia, acute granulocytic leukemia and acute nonlymphocytic leukemia.

General signs and symptoms of the early stages of acute myelogenous leukemia may mimic those of the flu or other common diseases. Signs and symptoms may vary based on the type of blood cell affected. Signs and symptoms of acute myelogenous leukemia include:

• Fever
• Weight loss
• Bone pain
• Lethargy and fatigue
• Shortness of breath
• Pale skin
• Frequent infections
• Easy bruising
• Unusual bleeding, such as frequent nosebleeds and bleeding from the gums

When to see a doctor
Make an appointment with a doctor if you develop any signs or symptoms that seem unusual or that worry you. Acute myelogenous leukemia worsens quickly if not treated, so a prompt diagnosis is helpful.

Acute myelogenous leukemia is caused by damage to the DNA of developing cells in your bone marrow. When this happens, blood cell production goes awry. The bone marrow produces immature cells that develop into leukemic white blood cells called myeloblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells.

It's not clear what causes the DNA mutations that lead to leukemia. Radiation, exposure to certain chemicals and some chemotherapy drugs may play a role. It's believed that most cases of acute myelogenous leukemia aren't inherited.

If you have signs or symptoms of acute myelogenous leukemia, your doctor may recommend you undergo diagnostic tests, including:

• Blood tests. Most people with acute myelogenous leukemia have too many white blood cells, not enough red blood cells and not enough platelets. The presence of blast cells — immature cells that are usually found in the bone marrow, but not normally circulating in the blood — is another indicator of acute myelogenous leukemia.
• Bone marrow test. A blood test can suggest leukemia, but it usually takes a bone marrow test to confirm the diagnosis. During a bone marrow biopsy, a needle is used to remove a sample of your bone marrow. Usually, the sample is taken from your hipbone (posterior iliac crest). The sample is sent to a laboratory for testing.
• Spinal tap (lumbar puncture). In some cases, it may be necessary to remove some of the fluid around your spinal cord to check for leukemia cells. Your doctor can collect this fluid by inserting a small needle into the spinal canal in your lower back.

If your doctor suspects leukemia, you may be referred to a doctor who specializes in cancer (oncologist) or a doctor who specializes in blood and blood-forming tissues (hematologist).

Determining your AML subtype
If your doctor determines you have AML, you may need further tests to determine the extent of the cancer and classify it into one of the eight subtypes of AML. In AML, the subtypes are based on:

• How mature the cancer cells are at the time of diagnosis
• How different the cancer cells are from normal cells
• The number and location of specific changes within the cancer cells' DNA

Your AML subtype helps determine which treatments may be best for you. Doctors are studying how different types of cancer treatment affect people with different AML subtypes.