This article has been reviewed and approved by Dr Niti Raizada for authenticity and medical correctness on 10 May 2020

All about Acute myeloid leukemia

Acute myeloid leukemia (AML) is a type of blood cancer that starts in your bone marrow. Bone marrow is the soft inner part of the last bones in your body. Their primary function is to produce blood cells. 

AML can spread to other parts of the body like the spleen, lymph nodes, liver, central nervous system, and testicles. The word ‘acute’ in acute myeloid leukemia indicates the disease’s quick progression. 

This disease mainly affects the myeloid cells, which are a precursor of different types of blood cells. These develop into red blood cells, platelets, and white blood cells other than lymphocytes. 

In acute leukemia, the stem cells in the bone marrow do not mature into normal blood cells as they should. The cells are immature and abnormal in function. The main treatments for AML are chemotherapy and bone marrow transplant. Without proper treatment, AML can be fatal. 


The exact cause of AML is not clear. One reason could be a DNA mutation that affects how the stem cells in your bone marrow mature into the white blood cells. This mutation also affects how the abnormal white blood cells multiply, leading to an increase in their number. Moreover, these white blood cells do not have enough infection-fighting capacity like normal mature white blood cells. 

Also, these abnormal, immature cells crowd out the normal blood cells like RBCs and platelets in your bone marrow. All these together cause various symptoms of leukemia. 

Risk factors

Some of the main risk factors are

  • Age - AML is more common in those above the age of 65.
  • Gender - Men are more likely to have this disease than women.
  • Smoking - Smoking increases your chances of getting AML. Tobacco has benzene and other known cancer-causing chemicals. 
  • Exposure to radiation - People exposed to very high levels of radiation are at a higher risk.
  • Genetic disorders - Genetic diseases such as Down syndrome may increase the risk of AML. 
  • Other blood disorders - People who have been diagnosed by other blood disorders are more prone. 
  • Previous history of chemotherapy for some other cancer - People who have had chemotherapy before are more at risk of AML.


Most of the symptoms of AML are due to the abnormality of white blood cells or a decrease of other blood cells like red blood cells and platelets. Some of the common early symptoms are:

  • Fever 
  • Pale skin
  • Shortness of breath
  • Bone pain
  • Easy bruising
  • Lethargy and fatigue
  • Unusual bleeding



If you have any signs and symptoms of AML, the doctor will ask to do a few tests. It is to see whether you have AML or not. 

  • Blood tests - A complete blood count shows how many of each type of blood cell you have. A peripheral blood smear will check for immature cells.
  • Imaging tests - X-rays, CT scans, MRIs, and ultrasounds give a detailed image of your internal body. They will help spot the location of infections or show when cancer has spread to other parts of your body.
  • Bone marrow tests - Your doctor will use a needle to take a sample of bone marrow. A specialist will then look at it under a microscope for signs of leukemia. 
  • Spinal tap - Your doctor will use a needle to take fluid from your spinal cord. A specialist will then check it for symptoms of leukemia. 
  • Genetic tests - A laboratory will look at your leukemia cells for a gene or a chromosome change. The results will help your doctors understand more about your condition and help them decide how to proceed with the treatment. 


There are two main stages of treatment for AML. These are:

  1. Induction - The first stage of treatment that aims to kill as many leukemia cells in your blood and bone marrow as possible.
  2. Consolidation - This is the next stage that aims to prevent the cancer cells from relapsing by killing any other remaining leukemia cells in your body. 


Some people will have to go through the induction stage twice as it isn’t always successful the first time. 


The common treatments for AML are:

Intensive chemotherapy:

Chemotherapy destroys cancer cells by using medicines. You will have the medicines by the mouth or injections through veins in your body. For undergoing intensive chemotherapy, you should be healthy and free of any kidney disease. Most people usually have two cycles of induction chemotherapy. Each cycle will last for a few days with periods of rest in between.       

You can go home during these periods of rest. During the treatment, you will also have regular blood tests as well as transfusions if there is a decrease in the number of healthy blood cells. You may also have to take antibiotics to prevent any infections. 

Side effects of chemotherapy are very common. Some of them include:

  • Diarrhea
  • Hair loss
  • Rashes 
  • Sore mouth and ulcers
  • Loss of appetite
  • Tiredness 
  • Infertility 


Non-intensive chemotherapy 

Non-intensive chemotherapy is a milder form of chemotherapy. It is ideal for those who are not healthy enough to withstand the side effects of intensive chemotherapy. The medications will be through a drip into a vein, by mouth or by injection under the skin. 

The two most commonly used drugs for a sub-type of AML called Abute Promyelocytic Leukemia are:

Arsenic trioxide - Doctors generally use it in cases where there is a relapse. It speeds up the death of leukemia cells and converts immature blood cells into healthy blood cells.

All-trans retinoic acid (ATRA) - It changes immature white blood cells into healthy cells, and it reduces the symptoms quickly. 

Bone marrow transplant and stem cell transplant

A bone marrow transplant (BMT) or a stem cell transplant is the best option if chemotherapy doesn’t work or is not enough. Before undergoing this treatment, the person receiving the transplant will have intensive high-dose chemotherapy and sometimes radiotherapy as well.

During the treatment, the doctor will transplant healthy stem cells from a donor bone marrow to the patient’s bloodstream. Once in the bloodstream, the stem cells will automatically move and occupy the narrow spaces. It will then start producing healthy blood cells. 

The doctor will advise you to stay in the hospital for a few weeks as you will have a higher risk of developing infections after BMT.

The type of transplant usually used in Relapsed Acute Myeloid Leukemia includes

Allogenic Stem Cell Transplant. There are three main types of Allogenic transplant -Related donor, Unrelated donor, and Haplo Identical donor.

AML Prognosis 

For most types of AML, 2 out of 3 people will go into remission after chemotherapy. Many factors affect remission, and some of the common ones are 

Age- The lower your age, the better your chances. People above 60 fare worse than younger ones especially children

White blood count - A high count (> 100,000/mm3) at the time of diagnosis will have less chance of remission

Prior history- If you had treatment earlier for any other cancer, your prognosis would be worse

AML treatment in India
AML treatment in India

References / Additional Reading
This article has been reviewed by Dr Niti Raizada for authenticity and medical correctness on 10 May 2020
Dr Niti Raizada
Dr Niti Raizada
MBBS, MD, DM-Medical Oncology, MRCP
Dr. Niti Raizada is a senior Medical Oncologist with over fifteen years of experience in the field. Dr Niti has special interests in the areas of Thoracic, Gastrointestinal, Breast, Gynaecological Oncology, and Bone Marrow Transplants. She did her MBBS at Gandhi Medical College, Bhopal; MD-General Medicine at G R Medical College, Gwalior, DNB-General Medicine from National Board Of Examination,DM from Adyar Cancer Institute Chennai and Fellowship in Hematology from Hammersmith Hospital and Imperial College,London. She is a member of American Society of Clinical Oncology,USA; Royal College of Physicians,Edinburgh,UK; Member of Pharmacy Committee,Member of DNB teaching program in Medical Oncology and European Society of Medical Oncology (ESMO).