Adult Acute Myeloid Leukemia
Table of Contents
What is adult acute myeloid leukemia?
Stages of adult acute myeloid leukemia
- Treatment Option Overview
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How adult acute myeloid leukemia is treated
- Treatment by stage
- Untreated Adult Acute Myeloid Leukemia
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- Adult Acute Myeloid Leukemia in Remission
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- Recurrent Adult Acute Myeloid Leukemia
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- To Learn More
What is adult acute myeloid leukemia?
Adult acute myeloid leukemia (AML) is a disease in which cancer (malignant) cells are
found in the blood and bone marrow. AML is also called acute nonlymphocytic leukemia or
ANLL. The bone marrow is the spongy tissue inside the large bones in the body. The bone
marrow makes red blood cells (which carry oxygen and other materials to all tissues of the
body), white blood cells (which fight infection), and platelets (which make the blood
clot).
Normally, the bone marrow makes cells called blasts that develop (mature) into several
different types of blood cells that have specific jobs to do in the body. AML affects the
blasts that are developing into white blood cells called granulocytes. In AML, the blasts
do not mature and become too numerous. These immature blast cells are then found in the
blood and the bone marrow.
Leukemia can be acute (progressing quickly with many immature blasts) or chronic
(progressing slowly with more mature looking cancer cells). Acute myeloid leukemia
progresses quickly. AML can occur in adults or children. (For more information on the
treatment of childhood AML, refer to the PDQ patient information statement on childhood
acute myeloid leukemia. Separate PDQ statements are also available for chronic lymphocytic
leukemia, chronic myelogenous leukemia, adult acute lymphocytic leukemia, and hairy-cell
leukemia).
AML is often difficult to diagnose. The early signs may be similar to the flu or other
common diseases. A doctor should be seen if the following signs or symptoms won't go away:
fever, weakness or tiredness, or achiness in the bones or joints.
If there are symptoms, a doctor may order blood tests to count the number of each of
the different kinds of blood cells. If the results of the blood tests are not normal, a
doctor may do a bone marrow biopsy. During this test, a needle is inserted into a bone and
a small amount of bone marrow is taken out and looked at under a microscope. A doctor can
then tell what kind of leukemia is present and plan the best treatment.
The chance of recovery (prognosis) depends on the type of AML and the patient's age and
general health.
Stages of adult acute myeloid leukemia
There is no staging for AML. The choice of treatment depends on whether the patient has
been treated.
Untreated
Untreated AML means no treatment has been given except to treat symptoms. There are too
many white blood cells in the blood and bone marrow, and there may be other signs and
symptoms of leukemia. Rarely, tumor cells can appear as a solid tumor called an isolated
granulocytic sarcoma or chloroma.
In remission
Treatment has been given, and the number of white blood cells and other blood cells in
the blood and bone marrow is normal. There are no signs or symptoms of leukemia.
Recurrent/refractory
Recurrent disease means the leukemia has come back after going into remission.
Refractory disease means the leukemia has not gone into remission following treatment.
How adult acute myeloid leukemia is treated
There are treatments for all patients with AML. The primary treatment of AML is
chemotherapy. Radiation therapy may be used in certain cases. Bone marrow transplantation
and biological therapy are being studied in clinical trials.
Chemotherapy is the use of drugs to kill cancer cells. Drugs may be given by mouth, or
they may be put into the body by a needle in a vein or muscle. Chemotherapy is called a
systemic treatment because the drug enters the bloodstream, travels through the body, and
can kill cancer cells throughout the body. Chemotherapy may sometimes be put into the
fluid that surrounds the brain through a needle in the brain or back (intrathecal
chemotherapy).
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink
tumors. Radiation for AML usually comes from a machine outside the body (external
radiation therapy).
If the leukemia cells have spread to the brain, radiation therapy to the brain or
intrathecal chemotherapy will be given.
There are two phases of treatment for AML. The first stage is called induction therapy.
The purpose of induction therapy is to kill as many of the leukemia cells as possible and
make patients go into remission. Once in remission with no signs of leukemia, patients
enter a second phase of treatment (called continuation therapy), which tries to kill any
remaining leukemia cells. Chemotherapy may be given for several years to keep a patient in
remission.
Bone marrow transplantation is used to replace the bone marrow with healthy bone
marrow. First, all of the bone marrow in the body is destroyed with high doses of
chemotherapy with or without radiation therapy. Healthy marrow is then taken from another
person (a donor) whose tissue is the same as or almost the same as the patient's. The
donor may be a twin (the best match), a brother or sister, or a person who is not related.
The healthy marrow from the donor is given to the patient through a needle in the vein,
and the marrow replaces the marrow that was destroyed. A bone marrow transplant using
marrow from a relative or from a person who is not related is called an allogeneic bone
marrow transplant.
Another type of bone marrow transplant, called autologous bone marrow transplant, is
being studied in clinical trials. To do this type of transplant, bone marrow is taken from
the patient and treated with drugs to kill any cancer cells. The marrow is then frozen to
save it. Next, high-dose chemotherapy is given with or without radiation therapy to
destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and
given to the patient through a needle in a vein to replace the marrow that was destroyed.
Another type of autologous transplant is called a peripheral blood stem cell
transplant. The patient's blood is passed through a machine that removes the stem cells
(immature cells from which all blood cells develop), then returns the blood to the
patient. This procedure is called leukapheresis and usually takes 3 or 4 hours to
complete. The stem cells are treated with drugs to kill any cancer cells and then frozen
until they are transplanted to the patient. This procedure may be done alone or with an
autologous bone marrow transplant.
A greater chance for recovery occurs if the doctor chooses a hospital that does more
than five bone marrow transplantations per year.
Biological therapy tries to get the body to fight cancer. It uses materials made by the
patient's body or made in a laboratory to boost, direct, or restore the body's natural
defenses against disease. Biological therapy is sometimes called biological response
modifier therapy or immunotherapy.
Treatment by stage
Treatment for adult AML depends on the type of AML, the patient's age and overall
health.
Standard treatment may be considered based on its effectiveness in past studies, or
participation in a clinical trial may be considered. Not all patients are cured with
standard therapy, and some standard treatments may have more side effects than are
desired. For these reasons, clinical trials are designed to find better ways to treat
cancer patients and are based on the most up-to-date information. Clinical trials are
ongoing in most parts of the country for most stages of adult AML. For more information,
call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at
1-800-332-8615.
Treatment will probably be systemic chemotherapy. If leukemia cells are found in the
brain, intrathecal chemotherapy may be given. Clinical trials are testing new drugs.
Treatment may be one of the following:
- 1. Systemic chemotherapy. Clinical trials are testing new chemotherapy drugs and new
ways of giving the drugs.
2. Clinical trials of bone marrow or peripheral stem cell transplantation.
Radiation therapy may be given to reduce symptoms. Patients may also choose to take
part in clinical trials of new chemotherapy drugs or bone marrow transplantation.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about adult acute myeloid leukemia, call the National Cancer Institute's
Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By
dialing this toll-free number, trained information specialists can help answer your
questions.
The Cancer Information Service also has a variety of booklets that are available to the
public and can be sent on request. The following booklets about leukemia may be helpful:
- What You Need To Know About Leukemia
Research Report: Bone Marrow Transplantation
The following general booklets on questions related to cancer may also be helpful:
- What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
- Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
There are many other places where people can get information about cancer treatment and
services. The social service office at a hospital can be checked for local and national
agencies that help with getting information about finances, getting to and from treatment,
getting care at home, and dealing with problems.
For more information from the National Cancer Institute, please write to this address:
- National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 10/97
If you want to know more about cancer and how it is treated, or if you wish to know
about clinical trials for your type of cancer, you can call the NCI's Cancer Information
Service at 1-800-422-6237, toll free. A trained information specialist can talk
with you and answer your questions.
Source: National Cancer Institute
National Institutes of Health
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