Leukemia can come on rather quickly, so being told you have acute myeloid leukemia (AML) can leave you ill prepared for such a serious diagnosis. The most important thing to know is there are treatment options for AML, and many people go on to live full and active lives after treatment. Learning what your AML diagnosis means and what happens afterwards can help you be an active participant in your care.
Acute Myeloid Leukemia Diagnosis
Some people have signs and symptoms that lead their doctor to test for AML, while others have no noticeable symptoms; the disease can be discovered accidentally through regular blood tests or testing for another problem. A blood cancer specialist performs a bone marrow biopsy to examine the cells directly.
After the initial diagnosis of AML, the next step is to confirm the subtype, which determines how you will be treated. The treatment of many other cancers is based on their stage—how far the cancer has spread throughout the body and how fast it grows. AML isn’t staged this way. It’s considered untreated or newly diagnosed. After treatment, it is in remission, relapsed (recurred), or refractory, which means it hasn’t responded to treatment.
AML Subtyping
For AML, doctors rely on subtype classifications that describe how many healthy blood cells are present, how the leukemia (abnormal) cells appear and how many there are, changes in their chromosomes, and if there are any genetic abnormalities marking the leukemia cells.
The leukemia is classified as subtype M0 to M7, according to the French-American-British classification system. M0 being the earliest of the subtypes—the least abnormal.
Another way to classify AML is the WHO (World Health Organization) system, which carefully describes the genetics of the abnormal blood cells. AML cell genetics are complex, but they also determine the behavior of the cells and what types of treatment might work best for you. Knowing the genetic details and cell markers helps your doctor plan treatment with the best chances of success.
Acute Myeloid Leukemia Treatment
A hematologist-oncologist will guide your treatment. These doctors specialize in cancers that affect the blood. Along with other members of the care team, your hematologist-oncologist will explain your full diagnosis and present your treatment options, including the benefits and risks of each. The goal of treatment is to cure the disease or bring about remission for as long as possible. Remission is when there are no signs of disease via medical tests.
Induction Chemotherapy
For most people with AML, chemotherapy is the first part of meeting the goal. Your doctor may use the term ‘induction’ treatment, since the goal is to induce remission. The most common induction phase treatment uses a combination of cytarabine (ara-C) and daunorubicin (daunomycin) or idarubicin.
Targeted therapy drugs are another treatment option for AML. The type of drug you receive may depend on the genetics of the leukemia cells. You may receive these drugs alone or alongside chemotherapy. Ask your doctor if you are a candidate for targeted therapy based on your subtype of AML.
Consolidation Chemotherapy
The goal of the second part of treatment—consolidation—is to eliminate any remaining (but undetectable) cancer cells and prevent a relapse. Doctors prescribe chemotherapy (typically cytarabine) with periods of rest in between.
In order to get your body to produce healthy blood cells, your oncologist may recommend you for a stem cell transplant, often called bone marrow transplant. Patients who do undergo a stem cell transplant must first have consolidation therapy with high doses of cytarabine to ensure all cancerous cells are gone. Ask your doctor why (or why not) you are a candidate for stem cell transplant.
Risks During Treatment
While receiving treatment for AML your immunity may be severely compromised, putting you at risk for complications, such as infections. Your care team will explain how to lower your risk of catching an infection and what to do if you start to feel ill.
Side effects can also be a serious problem for some people undergoing chemotherapy. If you are experiencing nausea and vomiting, or you have sores in your mouth, eating a healthy diet can be difficult. Since you need those nutrients, a dietitian can help you come up with a food plan that you can tolerate. Intravenous fluids can treat dehydration from vomiting (or not drinking enough liquids).
Fatigue, pain, easy bruising, and hair loss are also common side effects. Your doctor can prescribe additional medicine for pain and nausea. You may need a blood transfusion for serious changes in blood counts, such as low platelets or low red blood cell counts (anemia), as a consequence of chemotherapy.
Tell your doctor or someone on your care team if you are struggling with side effects or you develop new symptoms.
Acute Myeloid Leukemia Prognosis
Your prognosis, or outcome for AML varies depending on the AML subtype, your overall health and age, the response of the cancer cells to the chemotherapy and/or targeted therapy, and your ability to tolerate treatment. Up to 50 to 85% of patients enter remission after the first induction phase, but a relapse is possible.
The long-term disease-free survival rate for younger patients is 40 to 50%; overall, the survival rate is 20 to 40%. Keep in mind survival rates are based on patient data from prior years; they do not represent the current outlook, with the latest therapies. Your doctor can explain your prognosis based on your individual (or your child’s) circumstances.
