What is AML?

AML stands for acute myelogenous leukemia. It is a type of cancer that affects the bones and blood. It is a relatively rare form of leukemia but the likelihood of remission has almost tripled in the past 30 years.

Who gets AML?

About 13,410 Americans are expected to be diagnosed with acute myelogenous leukemia (AML) in 2007. The chance of getting AML increases with age. However, children and adults of any age can develop AML. About one in five children with leukemia has AML.

AML starts with a change to a single cell in the bone marrow. With AML, the leukemic cells are often referred to as blast cells.

You cannot catch AML from someone else. Very rarely, more cases of AML than would be expected are diagnosed within the same family. It is thought that children in these families inherit a gene that makes them more susceptible to developing AML. Research to improve the understanding of familial cancers and effective medical management of them is underway.

What are the symptoms?

Some of the signs and symptoms for AML are common to many illnesses. Some changes that a person with AML may have are:

• Tiredness or no energy
• Shortness of breath during physical activity
• Pale skin
• Swollen gums
• Slow healing of cuts
• Pinhead-size red spots under the skin
• Prolonged bleeding from minor cuts
• Mild fever
• Black-and-blue marks (bruises) with no clear cause
• Aches in bones or knees, hips or shoulder.

The best advice for any person troubled by any of these symptoms is to see a healthcare provider.

What are the treatments?

Blood and bone marrow tests are done to diagnose AML. A bone marrow aspiration and a bone marrow biopsy are two of the tests that are done. A bone marrow aspiration shows the cell-type and certain abnormalities by looking at proteins on the cell's surface. It can be used for cytogenetic analysis and other tests.

Cytogenetic analysis is a lab test to examine the chromosomes of the leukemic blast cells. Some changes to chromosomes give doctors information about how to treat their AML patients.

A bone marrow biopsy shows chromosome and gene abnormalities and how much disease is in the marrow. Both tests are also done to see if treatment is destroying leukemic blast cells. The doctor uses information from these tests to decide if leukemia is present, the type of treatment the patient needs and the best treatment for the patient.

The doctor will also consider the patient's age, the general health of the patient, and the presence of certain changes to chromosomes to determine the best treatment for the patient.

Patients with AML need to start chemotherapy right away. It is important to get medical care in a center where doctors are experienced in treating AML patients.

There are two parts of AML treatment, called induction therapy and consolidation therapy.  The aim of induction therapy is to kill as many AML cells as possible and get blood cell counts back to normal over time. When the aim of induction therapy is achieved it is called a remission. A patient in remission feels better over time and leukemia cells can't be seen in his or her blood or marrow.

Induction therapy is done in the hospital. Patients are often in the hospital for three to four weeks. Some patients may need to be in the hospital longer.

Many different drugs are used to kill leukemic cells. Each drug type works in a different way to kill the cells. Combining drug types can strengthen the effects of the drugs. New drug combinations are being studied. Two or more chemotherapies are usually used together to treat AML. Some drugs are given by mouth. Most chemotherapies are given through a catheter placed into a vein, usually in the patient's upper chest.

The first round of chemotherapy usually does not get rid of all the AML cells. Most patients will need more treatment. Usually the same drugs are used for more rounds of treatment to complete induction therapy.

More treatment is usually needed even after a patient with AML is in remission. This second part of treatment is called consolidation therapy. It is needed because some AML cells remain that are not found by common blood or marrow tests. Consolidation therapy is also done in the hospital. As with induction therarpy, patients may be in the hospital for three to four weeks, or sometimes longer. Consolidation therapy may include chemotherapy with or without an allogeneic stem cell transplant or autologous stem cell transplant.

Source: Leukemia & Lymphoma Society