Acute myeloid leukemia: What to know

Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. “Acute” means that this leukemia can progress rapidly if not treated, and “myeloid” refers to the type of cell this leukemia starts from.

While AML typically occurs in adults with median age of 67, MD Anderson does treat many adolescent and young adult AML patients. 

If you or a loved one has been diagnosed with AML, you have many questions. We spoke with Naveen Pemmaraju, M.D., to get answers to some common questions he hears about AML.

What is leukemia?

Leukemia is the name for a very large, complex, diverse group of malignant tumors that arise from the bone marrow and involve the blood. 

Can you explain the different types of leukemia? 

Leukemias are grouped by the type of cell affected and the rate of cell growth.

Acute leukemia involves an overgrowth of very immature blood cells. There are two main types of acute leukemia:

• Acute lymphocyte leukemia (ALL)
• Acute myeloid (or myelogenous) leukemia (AML)

Chronic leukemia involves an overgrowth of mature blood cells. The main types of chronic leukemia are:

• Chronic lymphoblastic leukemia (CLL)
• Chronic myeloid (or myelogenous) leukemia (CML) 

We also treat many patients with other subtypes of leukemia, such as myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN), aplastic anemia, blastic plasmacytoid dendritic cell neoplasm (BPDCN) and hairy cell leukemia. 

What are the symptoms of AML? 

There is generally a wide range of symptoms and presentations. Some patients may not have many symptoms and may only be diagnosed through blood testing when presenting in the clinic, through the emergency room, or in the hospital.

Others may experience common symptoms, such as fatigue, fevers/infections, bleeding and easy bruising. Some patients may be so ill that they present directly through the emergency room to the intensive care unit.

Are some people more likely to develop AML?

The exact cause of AML is unknown. Some associations/risk factors include:

• Exposure to ionizing radiation or specific chemical exposure
• Certain genetic/familial syndromes, such as familial platelet disorders with propensity to myeloid malignancies or inherited bone marrow failure syndromes
• Prior cancer treatment with either radiation or chemotherapy
• Patients with antecedent hematologic malignancy, such as MDS, MPN, aplastic anemia, BPDCN

How is AML typically treated?

Unfortunately, there’s not yet a reliable, standard therapy for most patients with AML. Many patients undergo chemotherapy and/or a stem cell transplant, which is a procedure that replaces defective or damaged cells in patients whose normal blood cells have been affected by cancer.

But stem cell transplants often aren’t an option for patients older than age 70, and some of the most common intensive chemotherapy regimens used for patients at younger ages may not work for all older patients. Often the best options may include a clinical trial. 

What clinical trials is MD Anderson offering for older AML patients?

At MD Anderson, we have a number of different AML clinical trials, some of which are part of our MDS/AML Moon Shot. Some of the frontline AML clinical trials we have for older patients include:

• A hypomethylator agent (such as Azacytidine, Decitabine or SGI-110) alone or with another agent
• Novel clinical trial drugs alone or in combinations, including targeted therapies based on a particular patient’s mutational profile (FLT3, IDH 1 or 2, or CD123, for example)
• Immunotherapy agents or immunotherapy in combination with chemotherapy

What other new research is on the horizon for AML? 

Besides the clinical trials I just mentioned, we’ll soon be looking at targeted therapy agents aimed at a particular molecular mutation or aberrant molecular pathways

Other approaches will soon include newer forms of immunotherapy, such as chimeric antigen receptor (CAR) T-cell therapy, bi-specific antibody therapies and others via upcoming clinical trials.

Why are patients with acute leukemia at increased risk of infection? 

If the white blood cell count, specifically the neutrophil count, is very low, this can weaken the immune system’s functioning and make it harder for a patient to fight off infections.

This can happen because of the leukemia itself or as a result of the cancer treatment. Generally, patients in active therapy may be placed on preventive antibiotics to help protect against some of the more common infections.

What’s your advice for newly diagnosed AML patients? 

Every patient is unique and each patient should have a serious conversation with their oncologist when diagnosed with AML. It’s important that you receive treatment from someone with a lot of experience treating AML and who has access to the latest clinical trials. I encourage new AML patients to schedule an appointment with an experienced hematologist at a comprehensive cancer center such as MD Anderson.

I also recommend finding out about your clinical trial options upfront, whether you have a new AML diagnosis or you have relapsed AML.