Acute myeloid leukaemia (AML)

What is acute myeloid leukaemia?

Acute myeloid leukaemia (also called AML or AML leukemia) is a cancer of the blood cells. If you have leukaemia your body makes some abnormal blood cells. These leukaemia cells behave differently from healthy blood cells. Acute means that it develops quickly and needs to be treated straight away.

AML is rare. Around 3,200 people in the UK are diagnosed with it each year. It can develop at any age. But it is more common in people who are aged 60 and over.

We have separate information about other types of leukaemia.

How acute myeloid leukaemia develops

Blood cells are made in the bone marrow, which is found inside our bones. Every blood cell grows from a stem cell in the bone marrow. There are 2 types of blood stem cell:

myeloid stem cells – which make red blood cells, platelets and other types of white blood cell. AML affects myeloid stem cells.
lymphoid stem cells – which make a type of white blood cell called lymphocytes.

What blood cells do

The stem cell divides to make an early stage of the blood cell called a blast. Usually they stay in the bone marrow until they have fully developed. Once this happens, they go into your blood and do different things:

white blood cells help fight and prevent infection
red blood cells carry oxygen from your lungs to all the cells in your body
platelets help the blood to clot and prevent bleeding and bruising.

What happens in AML

Normally, myeloid stem cells make blasts that develop into healthy blood cells. But in AML, some of these blast cells are abnormal and do not develop fully. These are the leukaemia cells.

Leukaemia cells cannot do the job of a normal blood cell. They also fill up the bone marrow. There is not enough space to make the usual numbers of healthy white blood cells, red blood cells and platelets your body needs.

The levels of these cells in your blood are measured in a test called a full blood count (FBC).

We have more detailed information about the blood and bone marrow. This includes what the levels of different blood cells usually are.

Types of acute myeloid leukaemia

AML can be grouped into different subtypes. Different tests are done on the leukaemia cells to find the type of leukaemia and look for gene changes in the cells.

This depends on:

the type of blood cells affected
gene changes inside the leukaemia cells
whether you had a blood disorder called myelodysplasia before developing AML
whether the AML is linked to previous chemotherapy treatment (called treatment-related AML or t-AML).

Knowing the subtype of AML may affect the treatment you have. Most types of AML are treated in a similar way.

Acute promyelocytic leukaemia

A type of AML called acute promyelocytic leukaemia (APL) is treated differently. APL affects about 6 in 100 (6%) adults with AML. We have more information on how APL is treated.

Symptoms of acute myeloid leukaemia

Most symptoms of acute leukaemia are caused by leukaemia cells filling the bone marrow. There is not enough space to make the usual numbers of healthy blood cells your body needs.

This can cause symptoms like:

being pale and tired because you have a low number of red blood cells (anaemia)
getting infections because you have too few healthy infection fighting white blood cells
unusual bleeding, such as bleeding gums or nose bleeds, or bruising due to low levels of platelets, which help the blood to clot.

We have more information about the symptoms of leukaemia.

Causes of acute myeloid leukaemia

Doctors do not know the cause of AML. But research is going on to find out more about it.

There are some things that may increase the risk of developing AML.

Age

AML is more common in people aged 60 and over.
Previous chemotherapy and radiotherapy

Having had certain types of chemotherapy or radiotherapy in the past may increase the risk of AML. This is called secondary leukaemia or treatment-related AML (t-AML).
Other blood cancers
People with certain other blood cancers that affect the bone marrow have a higher risk of developing AML:

myelodysplasia, also called MDS or myelodysplastic syndrome

myeloproliferative neoplasms (MPNs) which include essential thrombocythaemia (ET), polycythaemia vera, and myelofibrosis.

Rarely, chronic myeloid leukaemia (CML) may change (transform) into AML.
Genetic conditions

People with certain genetic conditions have a higher risk of developing leukaemia. These include Down’s syndrome and Fanconi’s anaemia.
High levels of radiation

Being exposed to very high radiation levels increases the risk of developing AML. For example, this might be after a nuclear accident. In the UK, it is very unlikely anyone would be exposed to radiation levels high enough to increase their risk.

In certain parts of the UK, a natural gas called radon can pass from the soil into the foundations of buildings. Exposure to high levels of radon is not common. It is not a risk factor for AML.
Exposure to chemicals

Rarely, AML is diagnosed in people who have had long-term exposure to certain chemicals. This is usually people who have worked in jobs that involve the chemical benzene. In the UK, exposure to benzene in the environment and at work is now regulated to minimise its risk to health.
Smoking

Smoking can increase the risk of AML. This may be because there is benzene in tobacco.
Family history

Sometimes AML or another blood cancer affects several relatives in a family. If you are worried about leukaemia in your family, talk to your GP or specialist doctor.

Diagnosis of acute myeloid leukaemia

Some people are diagnosed with AML after being taken to hospital with symptoms that developed quickly. Others see their GP about symptoms.

If it is possible you have leukaemia, you see a doctor (haematologist) who specialises in treating blood problems. At the hospital the haematologist and specialist nurse will talk to you about the tests you need.

If you think you may be pregnant, let your doctor know. Some tests can be harmful to an unborn baby. It is important to talk to your doctor so they can plan your care safely.

To diagnose AML your haematologist arranges tests your blood and bone marrow to check for signs of leukaemia cells. Further tests are done to find out more about the leukaemia cells.

Tests for AML include:

Blood tests

You will have blood tests to check the numbers of the different types of cells in your blood (full blood count) and to look for leukaemia cells.
Bone marrow biopsy

A doctor or nurse takes a small sample of bone marrow usually from the back of the hip bone (pelvis). The sample is sent to a laboratory to be checked for abnormal cells.
Immunophenotyping

This test looks for specific proteins on the surface of leukaemia cells. It helps identify the type of leukaemia and the type of blood cell (B or T cell) that has become abnormal. This test can also be used to look for very small numbers of leukaemia cells during, and at the end of treatment.
Cytogenetics and molecular tests
Different tests look for gene changes (mutations) inside the leukaemia cells. Cytogenetics studies chromosomes, which carry the genetic information for each of our cells.

The results tell your doctor the AML subtype you have and which drug treatments are likely to work well for you.

Tests may include:

G-banding – the genetic material from a leukaemia cell is coloured using a dye that stains the chromosomes. The chromosomes are then examined using a special microscope.

FISH (fluorescence in situ hybridisation) – looks for specific gene changes that may not be seen with G-banding. FISH looks at about 200 cells.

PCR (polymerase chain reaction) – this is a very sensitive test that looks for specific gene changes that cannot be seen under a microscope. It looks at a million or more cells. This test can also be used to look for very small amounts of leukaemia during, and at the end of treatment.

Next-generation sequencing (NGS) – these are techniques that allow doctors to quickly test for many different gene changes in the leukaemia cells at the same time. It can help doctors find different markers or proteins that are helping the leukaemia cells grow and find drugs to block this. NGS looks at about a million or more cells.

After your diagnosis you may have further tests including:

Tests to check your general health

This will include x-rays to check your lungs and heart health, and heart tests such as an ECG (echocardiogram). You may also have blood tests to check how your liver and kidneys are working, or to tests for infections, such as HIV and hepatitis.
Tissue (HLA) typing

If you might need a donor stem cell transplant as part of your treatment you have a blood test to find out your tissue type. The doctors use this to look for a person whose stem cells will be a suitable match for you (a donor).
Lumbar puncture

A lumbar puncture checks for leukaemia cells in the fluid around the brain and spinal cord.

The doctor puts a thin needle into the lower spine and removes a sample of this fluid to send to the laboratory for testing. You do not usually need a lumbar puncture at diagnosis but some people may have it done later.

Treatment for acute myeloid leukaemia

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). The aim of treatment for AML is to get rid of the leukaemia cells as quickly as possible, so your bone marrow can work normally again.

Treatment usually starts as soon as possible after diagnosis. You may have your treatment as part of a clinical trials. Your doctor will explain the different treatments and their advantages and disadvantages. They will also talk to you about things to think about when making treatment decisions.

Your treatment plan

This can depend on the type of AML you have and your general health. You may have intensive or non-intensive treatment.

Intensive treatment uses higher doses of chemotherapy to try to cure AML. You have it in 2 phases:

Intensive treatment – to get rid of the leukaemia cells in your blood and bone marrow. When this happens, it is called remission.
Non-intensive treatment – to get rid of any remaining leukaemia cells and reduce the risk of the leukaemia coming back.

You have some treatment as an inpatient in hospital, usually during induction.

If you have acute promyelocytic leukaemia (APL) you have different drugs. They may be given on their own or with chemotherapy.

Non-intensive treatment uses lower doses of chemotherapy or other drugs to control AML for as long as possible. It has less risk of serious side effects. You may have some treatments as an outpatient.

Before treatment starts, you have a central line or PICC line put in to give you chemotherapy and other treatments.

Your fertility

Your doctor will explain if your treatment may affect whether you can get pregnant or make someone pregnant . Some people may be able to have fertility preservation before treatment. Because treatment needs to start quickly, this is not always possible.

Tests during treatment

During treatment you will have blood tests and samples of your bone marrow taken to check for leukaemia cells. The results tell your doctor how well your treatment is working. It also helps them decide what treatment you may need next to give you the best chance of a cure.

If your test results show very small numbers of leukaemia cells (minimal residual disease) or none, your doctor will say you are in remission.

Treatment options for AML

Treatments for AML include:

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy the leukaemia cells. This is the main treatment for AML. You will usually have 2 or more chemotherapy drugs sometimes along with a targeted therapy drug.
Targeted therapy
Targeted therapy drugs target something that is helping leukaemia cells grow and survive. Different drugs may be used.

Gemtuzumab ozogamicin – you might have this if tests show the leukaemia cells make too much of a protein called CD33. It is given with chemotherapy as part of the first treatment for AML.

These drugs may be used if tests show the leukaemia cells have a gene change called an FLT3 mutation.

Midostaurin (Rydapt^®) is given between cycles of chemotherapy. You may also have it on its own for up to a year.

Gilteritinib (Xospata^®) might be given if AML does not respond to other treatments or comes back.

Another drug called venetoclax might be used if the leukaemia cells make too much of protein called BCL2. You usually have it with less intensive chemotherapy. Other targeted drugs might be used if AML does not respond to other treatments or comes back.
ATRA or arsenic trioxide

If you have a type of AML called acute promyelocytic leukaemia (APL), your treatment will include drugs called ATRA (All Trans-Retinoic Acid) and arsenic trioxide (ATO, Trisenox^®). You may have them on their own or with chemotherapy.
A stem cell transplant
A stem cell transplant using donor stem cells may be done to reduce the risk of AML coming back, or if AML comes back. You have this when you are in remission depending on:

the risk of AML coming back

whether a donor is available.

This treatment is not suitable or necessary for everyone. It can have serious risks.
Supportive treatments
Leukaemia and its treatment causes symptoms and side effects. Your doctor and nurses will monitor these. They will give you supportive treatments to prevent or manage them. This may include having:

Drugs such as, antibiotics, antiviral and antifungal drugs to treat or prevent different types of infections.

A blood transfusion if your red blood cells are low. This will increase your energy levels and reduce breathlessness.

A platelet transfusion if your platelets are low. This will reduce your risk of problems with bleeding.

Drugs called growth factors may be given to encourage the bone marrow to make white bloods cells.

We have more information about treatment for AML.

Related pages

Gemtuzumab ozogamicin (Mylotarg®) with daunorubicin and cytarabine (DA)

Managing side effects and recovery

It is important to look after yourself during treatment and while you recover. Some side effects may take months to improve. While your blood cells are still recovering you will need to avoid possible risks of infection.

After treatment, you will also be advised to avoid some vaccines that are not safe to have until your immune system recovers. Your doctor will explain more about this.

How quickly you get back to doing the things you did before, such as socialising, work or college, depends on how your blood cell levels recover.

We have more information about looking after yourself during treatment and recovery.

Sex

Leukaemia and its treatments may mean you feel too unwell or tired for sex. If you have low platelets your doctor may advise you to avoid penetrative sex until they recover. Changes, such as hair loss, may also affect how you think and feel about your body (body image). Usually, difficulties slowly improve as you recover.

Even if your treatment may cause infertility it is important to use contraception during treatment and for several months after it.

We have more information about sex during and after treatment in our information about looking after yourself during treatment and recovery.

After acute myeloid leukaemia treatment

Follow up after treatment

After your treatment, you will have regular check-ups which continue for several years. Your doctor asks you how you have been feeling and if you have any new or ongoing side effects.

You will have regular blood tests to check the number of normal cells in your blood. You may also have bone marrow samples taken to check for signs of leukaemia. Sometimes you may need other tests, such as x-rays or scans.

Many people find that they get very anxious before these appointments. This is normal. It may help to get support from family and friends.

If you have any problems, or notice any new symptoms between appointments, talk to your doctor or specialist nurse as soon as possible. Do not wait for your next appointment.

Related pages

Coping with treatment for acute leukaemia (leukemia)

If AML comes back

If AML comes back after treatment, it may be possible to have more treatment with chemotherapy and targeted or immunotherapy drugs. The aim is to get a second remission. Some people go on to have a stem cell transplant when they are in remission again.

Possible long term effects of treatment

AML treatment can sometimes cause side effects that are permanent or happen months or years later. They may include infertility, early menopause or an increased risk of heart problems later in life. These will not happen to everyone. Your doctor or nurse can explain how likely they are to affect you. They may give you advice about ways to prevent or manage long-term effects.

We have more information about possible long-term or late effects of AML treatment.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.

Getting support

Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse.

Macmillan can offer emotional, practical and financial help and support. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our acute myeloid leukaemia (AML) forum to talk with people who have been affected by acute myeloid leukaemia (AML), share your experience, and ask an expert your questions.

The organisations below offer information and support:

ACLT (African Caribbean Leukaemia Trust)
ACLT offers support for people from ethnic minorities affected by leukaemia and related illnesses.
Anthony Nolan
Anthony Nolan is the UK’s largest stem cell and bone marrow register.
Blood Cancer UK
Blood Cancer UK is a blood cancer research charity that provides information and support on any type of blood cancer.

About our information

References

Below is a sample of the sources used in our acute myeloid leukaemia (AML) information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Heuser M et al. Acute myeloid leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020, vol 3, issue 6. Available from www.esmo.org/ [accessed 2021].

NICE (National Institute for Health and Care Excellence). Blood and bone marrow cancers. Available from https://pathways.nice.org.uk/pathways/blood-and-bone-marrow-cancers [accessed August 2021].

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

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