You should see your GP if you or your child have possible symptoms of AML. Although it's highly unlikely that leukaemia is the cause, these symptoms should be investigated.
If your GP thinks you may have leukaemia, they'll arrange blood tests to check your blood cell production. If the tests suggest there's a problem, you'll be urgently referred to a haematologist (a specialist in treating blood conditions) for further tests and any necessary treatment.
AML occurs when specialised cells called stem cells, which are found in the bone marrow (a spongy material inside the bones), produce too many immature white blood cells. These immature cells are known as blast cells.
Blast cells don't have the infection-fighting properties of healthy white blood cells, and producing too many can lead to a decrease in the number of red blood cells (which carry oxygen in the blood) and platelets (cells that help the blood to clot).
It's not clear exactly why this happens and, in most cases, there's no identifiable cause. However, a number of factors that can increase your risk of developing AML have been identified. These include:
The outlook for AML largely depends on the specific type of AML you have, as well as your age and general health.
There are many subtypes of AML, which are classified according to various features –such as the specific genetic changes in the leukaemia cells. Some types of AML are more challenging to treat than others.
Even if treatment is initially successful, there's still a significant risk that the condition will return at some point during the next few years. If this happens, treatment may need to be repeated.
A number of medical trials have suggested that almost half of those aged under 60 diagnosed with AML will live for at least five years, and in some types of AML, such as acute promyeloid leukaemia (APML), around 85% will live for at least five years.
In general, the outlook for children with AML tends to be better than that of adults diagnosed with the condition.
Symptoms of acute myeloid leukaemia
The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells (blast cells) in your blood increases.
unusual and frequent bleeding, such as bleeding gums or nosebleeds
easily bruised skin
flat red or purple spots on the skin (petechiae)
bone and joint pain
a feeling of fullness or discomfort in your tummy (abdomen), caused by swelling of the liver or spleen
In rare cases of AML, the affected cells can spread into the central nervous system. This can cause symptoms such as dizziness.
When to seek medical advice
See your GP if you or your child have the symptoms listed above. Although it's highly unlikely that AML is the cause, these symptoms need to be investigated and treated promptly.
Causes of acute myeloid leukaemia
Acute myeloid leukaemia (AML) is caused by a DNA mutation in the stem cells in your bone marrow that produce red blood cells, platelets and infection-fighting white blood cells.
The mutation causes the stem cells to produce many more white blood cells than are needed.
The white blood cells produced are still immature, so they don't have the infection-fighting properties of fully developed white blood cells. These immature cells are known as "blast cells".
As the number of immature cells increases, the amount of healthy red blood cells and platelets decrease, and it's this fall that causes many of the symptoms of leukaemia.
It's not known what triggers the genetic mutation in AML, although a number of different factors that can increase your risk of developing the condition have been identified.
The main risk factors for AML are outlined below.
Being exposed to a significant level of radiation can increase your chances of developing AML, although this usually requires exposure at very high levels. For example, rates of AML are higher in people who survived the atomic bomb explosions in Japan in 1945.
In the UK, most people are unlikely to be exposed to levels of radiation high enough to cause AML. However, some people who have had radiotherapy as part of their treatment for previous cancer (see below) can be the exception.
Benzene and smoking
Exposure to the chemical benzene is a known risk factor for AML in adults. Benzene is found in petrol, and it's also used in the rubber industry, although there are strict controls to protect people from prolonged exposure.
Benzene is also found in cigarette smoke, which could explain why people who smoke have an increased risk of developing AML.
Previous cancer treatment
Treatment with radiotherapy and certain chemotherapy medications for an earlier, unrelated cancer can increase your risk of developing AML many years later.
Leukaemia that develops as a result of previous cancer treatment is called "secondary leukaemia" or "treatment-related leukaemia".
People with certain blood disorders – such as myelodysplasia, myelofibrosis or polycythaemia vera (PCV) – have an increased risk of developing AML.
People with certain genetic disorders, including Down’s syndrome and Fanconi’s anaemia, have an increased risk of developing leukaemia.
Other suggested triggers
A number of other environmental factors that could trigger AML have also been suggested, including childhood vaccinations and living near a nuclear power station or a high-voltage power line. However, there's no clear evidence to suggest that these can increase your risk of developing AML.
Diagnosing acute myeloid leukaemia
In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have lumbar puncture may be carried out. In this procedure, a needle is used to extract a sample of cerebrospinal fluid (which surrounds and protects your spine) from your back, so it can be checked for cancerous cells.
If cancerous cells are found in your nervous system, you may need to have injections of chemotherapy medication directly into your cerebrospinal fluid as part of your treatment.
Treating acute myeloid leukaemia
Acute myeloid leukaemia (AML) is an aggressive condition that develops rapidly, so treatment will usually begin a few days after a diagnosis has been confirmed.
As AML is a complex condition, it's usually treated by a multidisciplinary team (MDT) – a group of different specialists working together (see below).
Your treatment plan
Treatment for AML is often carried out in two stages:
Induction – the aim of this initial stage of treatment is to kill as many leukaemia cells in your blood and bone marrow as possible, restore your blood to proper working order and treat any symptoms you may have.
Consolidation – this stage aims to prevent the cancer returning (relapsing), by killing any remaining leukaemia cells that may be present in your body.
The induction stage of treatment isn't always successful and sometimes needs to be repeated before consolidation can begin.
If you have a relapse after treatment, both re-induction and consolidation may need to be carried out. This may be the same as your first treatment, although it's likely to involve different medications or a stem cell transplant (see below).
If you have acute myeloid leukaemia (AML), you may experience a number of complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment.
Some of the main complications associated with AML are outlined below.
Weakened immune system
Having a weakened immune system – being immunocompromised – is a common complication of AML.
Even if your blood is restored to normal working order with treatment, many of the medications that are used to treat AML can temporarily weaken your immune system.
This means you're more vulnerable to developing an infection, and any infection you develop could be more serious than usual. Complications arising from infection are the leading cause of death in people with AML. However, if treated early, nearly all infections respond to appropriate treatment.
Your treatment team can give a good estimation of the risk of infertility in your specific circumstances.
It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have their sperm samples stored. Similarly, women can have eggs or fertilised embryos stored, which can then be placed back into their womb, following treatment.
However, as AML is an aggressive condition that develops rapidly, there may not always be time to do this before treatment needs to start.
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