Understanding Acute Myeloid Leukemia
Acute myeloid leukemia (AML) is a cancer that affects the blood and bone marrow and is the most common type of acute leukemia in adults. With AML, the bone marrow (the center of the bone containing many blood vessels) makes abnormal white blood cells, red blood cells or platelets.
Normally, the bone marrow makes blood stem cells (immature cells) that over time, become mature blood cells. These immature myeloid stem cells become one of three types of mature blood cells:
- White blood cells that fight infection and disease,
- Red blood cells that carry oxygen and other substances to all tissues of the body,
- And platelets that form blood clots to stop bleeding.
In AML, the myeloid stem cells usually become a type of immature, abnormal white blood cell called myeloblasts. Sometimes in AML, too many stem cells become abnormal red blood cells or platelets. These abnormal white blood cells, red blood cells or platelets are also called leukemia cells or blasts.
Leukemia cells can build up in the bone marrow and blood so there is less room for healthy white blood cells, red blood cells and platelets. When this happens, infection, anemia or easy bleeding may occur. The leukemia cells can spread outside the blood to other parts of the body, including the central nervous system (brain and spinal cord), skin and gums.
AML usually gets worse quickly if it is not treated. Chances of recovery and treatment options depend on:
- The age of the patient.
- The subtype of AML.
- Whether the patient received chemotherapy in the past to treat a different cancer.
- Whether there is a history of a blood disorder such as myelodysplastic syndrome.
- Whether the cancer has spread to the central nervous system.
- Whether the cancer has been treated before or has come back.
AML may be treated with chemotherapy, radiation therapy, chemotherapy with stem cell transplant, and in some cases, drug therapies including arsenic trioxide and all-trans retinoic acid (ATRA). Treatment usually has two phases:
- Remission induction therapy is the first phase of treatment. The goal is to kill the leukemia cells in the blood and bone marrow to put the leukemia into remission.
- Post-remission therapy is the second phase and begins after the leukemia is in remission. The goal is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse.
In addition to standard (currently used) treatments, new types of treatments are being tested in clinical trials, including monoclonal antibody therapy, a targeted therapy that may cause less harm to normal cells than chemotherapy or radiation therapy. According to the National Cancer Institute, patients who take part in clinical trials can help improve the way cancer will be treated in the future. They note that even when clinical trials do not lead to effective new treatments, such trials often answer important questions and help move research forward.
Treatment Planning: Questions to Ask Your AML Care Team
Cancer Support Community offers advice to those diagnosed with AML, to help them sort through the whirlwind of information, decisions, and life adjustments related to their diagnosis. They suggest having a list of specific questions patients should ask at every stage:
- What subtype do I have?
- Does my cancer test positive for any biomarkers that help make treatment decisions, such as FLT3, TP53, IDH1, IDH2, NPM1, and CEBPA?
- What are my different treatment options?
- Are there any clinical trials that would be right for me? How do I find out more about them?
- Am I healthy enough for high-dose chemotherapy?
- Should I be thinking about a stem cell transplant? If so, when will the transplant team start looking for a donor?
- Can my leukemia be cured? What would a “cure” look like for me?
- What treatment do you recommend for me, and why?
- What are the risks of this treatment? What are the benefits?
- What are the side effects (short- and long-term)? What can I do to prepare for them?
- Do I need to go to an academic medical center for my treatment?
- How long will I be in the hospital?
- Do I need to go get dental work done before beginning treatment?
- How will treatment affect my everyday life? Will I need to miss work/school?
- How much will this treatment cost? Will it be covered by my insurance? Is there a social worker or financial counselor that I could meet with?
- How do I apply for disability?
Cancer Support Community also offers advice on preparing for in-hospital treatment, including:
- Consider travel arrangements if the nearest treatment center is far away, or if you decide to join a clinical trial.
- Anticipate long stays in the hospital, for weeks to months. A hospital social worker or financial counselor can aid you in researching and coordinating insurance, travel, and housing.
- Often patients with AML will not be able to work during treatment. Talk to your hospital social worker and workplace Human Resources right away about how to apply for short- and long-term disability benefits. It can take up to six months for long-term benefits to begin.
- Start thinking about how friends and family can help. You can expect to need six to nine months of help with household tasks, cooking, cleaning, errands, rides, childcare, financial support, etc.
Financial Assistance for AML Treatment
The HealthWell Foundation offers an Acute Myeloid Leukemia (AML) fund to provide medication copayment and insurance premium assistance to eligible AML patients on Medicare. HealthWell will provide up to $10,000 in financial assistance to individuals who have annual household incomes up to 500 percent of the federal poverty level. Grants through the fund assist AML patients in covering out-of-pocket costs for treatment.
PDQ® Adult Treatment Editorial Board. PDQ Adult Acute Myeloid Leukemia Treatment. Bethesda, MD: National Cancer Institute. Updated 3/6/2020. Available at: https://www.cancer.gov/types/leukemia/patient/adult-aml-treatment-pdq. Accessed 5/27/2021. [PMID: 26389377]
Cancer Support Community. Frankly Speaking About Cancer: Treatment for Acute Myeloid Leukemia. Accessed 5/27/2021.
Cancer Support Community. Frankly Speaking About Cancer: Acute Myeloid Leukemia. Accessed 5/27/2021.