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Overview

Leukaemia is cancer of the white blood cells. Acute leukaemia means it progresses quickly and aggressively, and usually requires immediate treatment.

Acute leukaemia is classified according to the type of white blood cells affected.

The 2 main types of white blood cells are:

  • lymphocytes – which fight viral infections
  • myeloid cells – which do different things, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage 

This topic focuses on acute myeloid leukaemia (AML), which is an aggressive cancer of the myeloid cells.

Symptoms of AML

The symptoms of AML usually develop over a few weeks and become worse over time.

Symptoms can include:

  • looking pale or "washed out"
  • feeling tired or weak
  • breathlessness
  • frequent infections
  • unusual and frequent bruising or bleeding, such as bleeding gums or nosebleeds
  • losing weight without trying to

Seeking medical advice

Speak to a 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 specialist in treating blood conditions (haematologist) for further tests and treatment.

What causes AML?

It's not clear exactly what causes AML and, in most cases, there's no identifiable cause.

But some things can increase your risk of getting AML, including:

  • previous chemotherapy or radiotherapy
  • exposure to very high levels of radiation (including previous radiotherapy treatment)
  • smoking and other exposure to benzene, a chemical used in manufacturing that's also found in cigarette smoke
  • having a blood disorder or some genetic conditions, such as Down's syndrome

Who's affected

AML is a rare type of cancer, with around 3,100 people diagnosed with it each year in the UK.

The risk of developing AML increases with age. It's most common in people over 75.

How AML is treated

Treatment for AML needs to begin as soon as possible, as it can develop quickly.

Chemotherapy is the main treatment for AML. It's used to kill as many leukaemia cells in your body as possible and reduce the risk of the condition coming back (relapsing).

In some cases, intensive chemotherapy and radiotherapy may be needed, in combination with a bone marrow or stem cell transplant.

Help and support

There are organisations that offer information, advice and support if you or a family member has been diagnosed with AML.

These include:

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Symptoms

The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells increases.

Symptoms of AML can include:

  • skin looking pale or "washed out"
  • tiredness
  • breathlessness
  • having a high temperature, and feeling hot or shivery (fever)
  • sweating a lot
  • losing weight without trying
  • frequent infections
  • unusual and frequent bleeding, such as bleeding gums or nosebleeds
  • easily bruised skin
  • flat red or purple spots on the skin
  • bone and joint pain
  • a feeling of fullness or discomfort in your tummy
  • swollen glands in your neck, armpit or groin that may be sore when you touch them

When to seek medical advice

See a GP if you or your child have the symptoms of AML.

Although it's highly unlikely that AML is the cause, these symptoms need to be investigated and treated promptly.

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Causes

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 do not have the infection-fighting properties of fully developed white blood 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.

Increased risk

It's not known what triggers the genetic mutation in AML, although a number of different things can increase your risk of developing the condition.

Radiation exposure

Being exposed to a significant level of radiation can increase your chances of developing AML, although this usually requires exposure at very high levels.

In the UK, most people are unlikely to be exposed to levels of radiation high enough to cause AML. 

But some people who have had radiotherapy as part of a previous cancer treatment may have a bigger chance of getting AML.

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.

Blood disorders

People with certain blood disorders, such as myelodysplasia, myelofibrosis or polycythaemia vera, have an increased risk of developing AML.

Genetic disorders

People with certain genetic conditions, including Down's syndrome and Fanconi's anaemia, have an increased risk of developing leukaemia.

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Diagnosis

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 blood tests.

A high number of abnormal white blood cells, or a very low blood count in the test sample, could indicate leukaemia.

If this is the case, you'll be urgently referred to a a specialist in treating blood conditions (haematologist).

A haematologist may carry out further tests.

Bone marrow biopsy

To confirm a diagnosis of AML, a small sample of your bone marrow will be taken to examine under a microscope. This procedure is known as a bone marrow biopsy. 

The doctor or nurse will numb an area of skin at the back of your hip bone, before using a thin needle to remove a sample of liquid bone marrow.

In some cases, they'll remove bone and bone marrow together.

You will not feel any pain during the procedure, but it can feel uncomfortable when the sample is being taken.

You may also have bruising and discomfort for a few days afterwards.

The procedure takes around 20 to 30 minutes.

The bone marrow sample will be checked for cancerous cells. If cancerous cells are present, the biopsy can also be used to determine the type of leukaemia you have.

Further tests

Other tests can be used to get more information about the progress and extent of your AML. They can also help decide how it should be treated.

Genetic testing

Genetic tests can be carried out on blood and bone marrow samples to find out what type of AML you have. This can help doctors make decisions about the most appropriate treatment.

Scans

If you have AML, an X-ray or an ultrasound scan of the heart (echocardiogram) may be used to check your organs, such as your heart and lungs, are healthy.

These tests help doctors assess your general health before they decide on the most appropriate treatment for you.

Lumbar puncture

In rare situations where it's thought there's a risk that AML has spread to your nervous system, a lumbar puncture may be carried out.

In this procedure, a needle is used to extract a sample of the fluid that surrounds and protects your spine (cerebrospinal fluid) so it can be checked for cancerous cells.

If cancerous cells are found in your nervous system, it may affect your treatment.

Coping with your diagnosis

Being diagnosed with AML can be particularly difficult, as the condition usually comes on suddenly and treatment has to be started quickly.

This can be upsetting and confusing. But finding out what type of leukaemia you have, what treatment you need and how treatment will affect you can help you cope better and feel more in control.

The Cancer Research UK website has more information and advice about coping with AML.

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Treatment

If you have acute myeloid leukaemia (AML), you may experience complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment.

Weakened immune system

Having a weakened immune system 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 very common in people with AML. But if treated early, nearly all infections respond to appropriate treatment.

  • You may be advised to:
  • take regular doses of antibiotics to prevent bacterial infections
  • maintain good personal and dental hygiene
  • avoid contact with anyone who's known to have an infection – even if it's a type of infection that you were previously immune to, such as chickenpox or measles
  • check with your GP to make sure your vaccinations are up-to-date – you will not be able to have any vaccine that contains "live" viruses or bacteria, such as the shingles vaccine and MMR vaccine (against measles, mumps and rubella)

Report any possible symptoms of an infection to your treatment unit immediately as prompt treatment may be needed to prevent complications.

Symptoms of an infection can include:

  • a sore throat
  • a very high temperature, and feeling hot or shivery
  • flu-like symptoms, such as headaches, aching muscles and tiredness
  • breathlessness
  • pain when peeing

Bleeding

If you have AML, you might bleed and bruise more easily because of the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive.

People with advanced AML are more vulnerable to excessive bleeding inside their body.

Serious bleeding can occur:

  • inside the skull (intracranial haemorrhage) – causing symptoms such as a severe headache, stiff neck, vomiting and confusion
  • inside the lungs (pulmonary haemorrhage) – causing symptoms such as coughing up blood, breathing difficulties and a bluish skin tone (cyanosis)
  • inside the stomach (gastrointestinal haemorrhage) – causing symptoms such as vomiting blood and passing poos that are very dark or tar-like in colour

All these types of haemorrhage should be regarded as medical emergencies.

Dial 999 immediately and ask for an ambulance if you think a haemorrhage is occurring.

Infertility

Many of the treatments that are used to treat AML can cause infertility. This is often temporary, but in some cases can be permanent.

People particularly at risk of permanent infertility are those who have received high doses of chemotherapy and radiotherapy in preparation for a bone marrow or stem cell transplant.

Your treatment team can talk to you about the risk of infertility in your specific circumstances.

It may be possible to do things to help keep your fertility before you begin your treatment.

For example, men can have their sperm samples stored. Women can have eggs or fertilised embryos stored, which can then be placed back into their womb following treatment.

But 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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Complications

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 are more vulnerable to developing an infection, and any infection 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.

Therefore, you may be advised to:

  • take regular doses of antibiotics to prevent bacterial infections
  • maintain good personal and dental hygiene
  • avoid contact with anyone who is known to have an infection – even if it is a type of infection that you were previously immune to, such as chickenpox or measles
  • check with your GP to ensure that all of your vaccinations are up to date, although you will not be able to have any vaccine containing "live" viruses or bacteria, such as the shingles vaccine and the MMR vaccine (against measles, mumps and rubella)

You should report any possible symptoms of an infection to your treatment unit immediately, as prompt treatment may be required to prevent complications.

Symptoms of an infection can include:

  • a high temperature (fever)
  • a headache
  • aching muscles
  • diarrhoea
  • tiredness

Bleeding

If you have AML, you will bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive when it does occur.

People with advanced AML are more vulnerable to excessive bleeding inside their body, which is the second most common cause of death in people with the condition.

Serious bleeding can occur:

  • inside the skull (intracranial haemorrhage) – causing symptoms such as a severe headache, stiff neck, vomiting and confusion
  • inside the lungs (pulmonary haemorrhage) – causing symptoms such as coughing up blood, breathing difficulties and a bluish skin tone (cyanosis)
  • inside the stomach (gastrointestinal haemorrhage) – causing symptoms such as vomiting blood and passing stools (faeces) that are very dark or tar-like in colour

All these types of haemorrhage should be regarded as a medical emergency. You should dial 999 immediately and ask for an ambulance if you think a haemorrhage is occurring.

Infertility

Many of the treatments that are used to treat acute leukaemia can cause infertility. This is often temporary, but in some cases can be permanent.

People who are particularly at risk of permanent infertility are those who have received high doses of chemotherapy and radiotherapy in preparation for a bone marrow or stem cell transplant.

Your treatment team can give a good estimation regarding 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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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 24/09/2019 11:16:35