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Adult acute myeloid leukemia


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is adult acute myeloid leukemia?
STAGE EXPLANATION
Stages of adult acute myeloid leukemia
Untreated
In remission
Recurrent/refractory
TREATMENT OPTION OVERVIEW
How adult acute myeloid leukemia is treated
Treatment by stage
UNTREATED ADULT ACUTE MYELOID LEUKEMIA
ADULT ACUTE MYELOID LEUKEMIA IN REMISSION
RECURRENT ADULT ACUTE MYELOID LEUKEMIA
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


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 summary on childhood acute myeloid leukemia. Separate PDQ summaries 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.


STAGE EXPLANATION


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.


TREATMENT OPTION OVERVIEW


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.


UNTREATED ADULT ACUTE MYELOID LEUKEMIA

Treatment will probably be systemic chemotherapy. If leukemia cells are found in the brain, chemotherapy will be injected directly into the spinal cord (intrathecal). Clinical trials are testing new drugs.


ADULT ACUTE MYELOID LEUKEMIA IN REMISSION

Treatment will most likely be systemic chemotherapy, a clinical trial evaluating new chemotherapy drugs and new ways of giving drugs, or a clinical trial evaluating bone marrow or peripheral stem cell transplantation.


RECURRENT ADULT ACUTE MYELOID LEUKEMIA

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

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: 07/1999


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.


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