Leukaemia is a type of cancer affecting the white blood cells. Acute leukaemia means that the disease progresses quickly and requires urgent treatment.
Types of White Blood Cells
Acute leukaemia is categorized based on the type of white blood cells involved:
- Lymphocytes: Primarily responsible for combating viral infections.
- Myeloid Cells: Perform various roles, including fighting bacterial infections, defending against parasites, and controlling the spread of tissue damage.
This section focuses on acute myeloid leukaemia (AML), an aggressive cancer of the myeloid cells. For information on other types of leukaemia, visit our pages on:
- Acute Lymphoblastic Leukaemia (ALL)
- Chronic Myeloid Leukaemia (CML)
- Chronic Lymphocytic Leukaemia (CLL)
Signs and Symptoms of AML
AML symptoms typically worsen over a few weeks and may include:
- Pale skin
- Fatigue and persistent tiredness
- Breathlessness
- Frequent infections
- Unusual and frequent bleeding, such as bleeding gums or nosebleeds
In advanced cases, AML can make you highly susceptible to life-threatening infections or severe internal bleeding.
When to Seek Medical Advice
If you or your child experience symptoms suggestive of AML, contact your GP for an evaluation. Although these symptoms are more commonly caused by other conditions, they require prompt investigation.
Your GP may order blood tests to assess blood cell production. If abnormal results are detected, you will be urgently referred to a haematologist (a specialist in blood disorders) for further testing and treatment.
Causes of AML
AML occurs when stem cells in the bone marrow produce an excessive number of immature white blood cells called blast cells. These cells lack the infection-fighting capabilities of healthy white blood cells, which leads to a decrease in red blood cells (oxygen transporters) and platelets (blood clotting cells).
Risk Factors for AML
Although the precise cause of AML remains unclear, several factors can increase the risk of developing this condition:
- Previous chemotherapy or radiotherapy for other cancers
- High exposure to radiation, including prior radiotherapy
- Exposure to benzene, a chemical found in cigarette smoke and used in manufacturing
- Genetic or underlying blood disorders, such as Down’s syndrome
Who is Affected by AML?
AML is a rare form of cancer, and the risk of developing it increases with age. It is most common in individuals over 65 years old.
Treatment for AML
Due to its aggressive nature, treatment for AML typically begins promptly after diagnosis. The primary treatment option is chemotherapy, which aims to eliminate as many leukaemia cells as possible and reduce the risk of relapse.
In certain cases, intensive chemotherapy combined with radiotherapy may be required, along with a bone marrow or stem cell transplant to achieve a cure.
Symptoms of Acute Myeloid Leukaemia (AML)
Acute Myeloid Leukaemia (AML) is an aggressive form of cancer affecting white blood cells, and its symptoms usually develop over a few weeks, becoming increasingly severe as the number of immature white blood cells (blast cells) rises in the bloodstream.
Common Symptoms of AML
Symptoms of AML may include:
- Pale Skin: Reduced red blood cell production can cause a noticeable pallor.
- Tiredness and Fatigue: Persistent tiredness is often due to anaemia (low red blood cell count).
- Breathlessness: Reduced oxygen-carrying capacity can make you feel short of breath.
- High Temperature (Fever): Often linked to infections, as the immune system becomes compromised.
- Excessive Sweating: Particularly at night (night sweats).
- Unexplained Weight Loss: Sudden or unintended weight loss is a common symptom.
- Frequent Infections: The body’s inability to produce healthy white blood cells makes you more susceptible to infections.
- Unusual and Frequent Bleeding: Examples include bleeding gums or frequent nosebleeds.
- Easily Bruised Skin: Bruising occurs due to reduced platelet counts.
- Flat Red or Purple Spots (Petechiae): Tiny red or purple spots caused by bleeding under the skin.
- Bone and Joint Pain: This may occur as leukaemia cells build up in the bone marrow.
- Feeling of Fullness or Discomfort in the Abdomen: This is caused by swelling of the liver or spleen.
Rare Symptoms: Spread to the Central Nervous System (CNS)
In rare cases, AML cells can invade the central nervous system, leading to symptoms such as:
- Headaches
- Seizures (Fits)
- Vomiting
- Blurred Vision
- Dizziness
When to Seek Medical Advice
If you or your child experience any of these symptoms, it is essential to see your GP. While it is unlikely that AML is the cause, these symptoms should be promptly investigated and treated to ensure proper diagnosis and care.
Causes of Acute Myeloid Leukaemia (AML)
Acute Myeloid Leukaemia (AML) arises due to a DNA mutation in the stem cells found within your bone marrow, which produce red blood cells, platelets, and infection-fighting white blood cells. This mutation prompts the production of an excessive number of white blood cells, but these cells remain immature and are unable to perform their infection-fighting role. Such immature cells are referred to as blast cells.
How AML Develops
As blast cells accumulate, the number of healthy red blood cells and platelets diminishes, leading to many of the characteristic symptoms of AML, such as fatigue, increased susceptibility to infections, and easy bruising.
Risk Factors for AML
While the precise cause of the genetic mutation leading to AML remains unclear, certain factors have been identified that can increase your risk of developing the condition. These risk factors are outlined below:
1. Radiation Exposure
Exposure to significant levels of radiation can heighten your risk of developing AML, although it generally requires exposure at high levels. For example, higher rates of AML have been observed in individuals who survived the atomic bomb explosions in Japan in 1945.
In the UK, most people are not exposed to radiation levels sufficient to cause AML. However, individuals who have undergone radiotherapy as part of previous cancer treatment may have an elevated risk.
2. Benzene and Smoking
Benzene exposure is a known risk factor for developing AML in adults. Benzene is present in petrol and is also used in the rubber industry, although stringent regulations limit prolonged exposure.
Cigarette smoke contains benzene, which may explain why smokers are at a higher risk of developing AML.
3. Previous Cancer Treatment
People who have received radiotherapy or certain chemotherapy medications for previous, unrelated cancers are at an increased risk of developing AML years later. This form of leukaemia is known as ‘secondary leukaemia’ or ‘treatment-related leukaemia’.
4. Blood Disorders
Certain pre-existing blood disorders are associated with an increased risk of AML. These include:
- Myelodysplasia
- Myelofibrosis
- Polycythaemia vera (PCV)
5. Genetic Disorders
Individuals with certain genetic disorders also have a heightened risk of developing AML. Notable examples include:
- Down’s syndrome
- Fanconi’s anaemia
6. Other Potential Triggers
A few environmental factors have been suggested as potential triggers for AML, such as:
- Childhood vaccinations
- Living near a nuclear power station
- Residing near high-voltage power lines
However, there is no conclusive evidence linking these factors directly to an increased risk of developing AML.
Reducing Your Risk
While many of the risk factors for AML are beyond your control, maintaining a healthy lifestyle by avoiding smoking and limiting exposure to harmful chemicals can help reduce certain risk factors. Regular health check-ups and being aware of your medical and family history can also contribute to early detection and management of potential risks.
Diagnosing Acute Myeloid Leukaemia (AML)
Diagnosing acute myeloid leukaemia (AML) starts with an evaluation by your GP who will check for any physical symptoms and perform blood tests.
Initial Diagnosis Steps
A blood test revealing a high number of abnormal white blood cells or a very low blood count may indicate leukaemia. If your blood test results are concerning, you’ll be referred urgently to a haematologist – a specialist in blood disorders – for further evaluation and testing.
Bone Marrow Biopsy
To confirm a diagnosis of AML, a bone marrow biopsy is often necessary. This procedure allows for the collection and examination of bone marrow to identify cancerous cells.
- Procedure Details: A local anaesthetic is used to numb the skin at the back of your hip bone. A thin needle is then used to extract a sample of liquid bone marrow. In some instances, a larger needle may be used to remove a small amount of bone and bone marrow together.
- Pain and Recovery: The procedure itself is painless due to the anaesthetic, but some bruising and discomfort may persist for a few days. The entire procedure takes around 15 minutes, and an overnight hospital stay is not usually required.
- Diagnostic Purpose: The bone marrow sample will be examined to check for the presence of cancerous cells, and, if present, to determine the specific type of leukaemia.
Additional Tests for AML Diagnosis
To gain a more comprehensive understanding of the progression and extent of your AML, additional tests may be necessary. These tests also help tailor the most effective treatment plan.
Genetic Testing
Genetic tests on blood and bone marrow samples can identify the genetic makeup of the cancerous cells. Understanding specific genetic variations present in AML helps determine the most suitable treatment options.
For example:
- Patients with a type of AML known as acute promyelocytic leukaemia (APML) typically respond well to a medication called All Trans-Retinoic Acid (ATRA).
Imaging Scans
- Computerised Tomography (CT) Scan
- X-ray
- Echocardiogram (ultrasound scan of the heart)
These scans assess the health of your organs, such as the heart and lungs, which is crucial before determining the best treatment approach.
Lumbar Puncture
In rare cases where there is a risk that AML has spread to your central nervous system (CNS), a lumbar puncture may be recommended. This procedure involves extracting a sample of cerebrospinal fluid (CSF) using a needle inserted into your lower back. The sample is then tested for cancerous cells.
- Treatment Implications: If cancerous cells are found in your CNS, you may require chemotherapy injections directly into your cerebrospinal fluid as part of your treatment.
Treating Acute Myeloid Leukaemia (AML)
Acute Myeloid Leukaemia (AML) is a rapidly progressing form of cancer, necessitating treatment shortly after diagnosis. Since AML is complex, treatment is typically managed by a multidisciplinary team (MDT) of specialists working together.
Overview of Treatment Stages
AML treatment is generally delivered in two main stages:
- Induction – The goal is to eliminate as many leukaemia cells as possible from your blood and bone marrow, restore healthy blood production, and manage any symptoms.
- Consolidation – This phase aims to prevent a relapse by eradicating any remaining leukaemia cells.
In some cases, induction may need to be repeated if the initial treatment is not fully successful. For patients who relapse after treatment, re-induction and consolidation are required, possibly using alternative medications or stem cell transplantation.
Patients who are at high risk of complications—often due to age (typically over 75) or underlying health conditions—may undergo less intensive chemotherapy. While this approach may not completely eliminate cancerous cells, it can help manage symptoms and slow disease progression.
Induction Therapy
Initial treatment depends on patient fitness and health status.
Intensive Chemotherapy
For those eligible for intensive induction chemotherapy, a combination of high-dose chemotherapy medications is administered to destroy leukaemia cells in the blood and bone marrow.
- Hospital Care: This phase is conducted in a hospital or specialized centre due to the need for close medical supervision. Frequent blood transfusions are often necessary due to the low count of healthy blood cells.
- Infection Control: Patients are particularly susceptible to infections, requiring a clean environment and potentially preventive antibiotics.
Duration: The induction phase may last four weeks to several months, depending on the patient’s response. Patients may transition to outpatient treatment if their symptoms improve.
Administration: Chemotherapy medications are typically delivered through a central line into a blood vessel near the heart or a peripherally inserted central catheter (PICC) in the arm. Rarely, medication may also be injected directly into the cerebrospinal fluid (CSF).
Common Side Effects:
- Nausea, vomiting, and diarrhoea
- Loss of appetite
- Mouth ulcers and sore mouth (mucositis)
- Fatigue and skin rashes
- Hair loss
- Potential infertility (temporary or permanent)
Speak to your care team if you experience troublesome side effects, as medications and support are available to help you manage them.
Non-Intensive Chemotherapy
For patients unable to undergo intensive chemotherapy, non-intensive treatment options are available. This treatment primarily aims to control the leukaemia and manage symptoms, reducing significant side effects.
- Administration: Non-intensive chemotherapy may be given via drip, oral medication, or subcutaneous injection, often on an outpatient basis.
All Trans-Retinoic Acid (ATRA)
Patients with acute promyelocytic leukaemia (APML) may be prescribed ATRA capsules alongside chemotherapy to transform immature white blood cells into mature, healthy cells. Side effects include headaches, nausea, dry mouth/skin/eyes, and bone pain.
Consolidation Therapy
After successful induction therapy, the next step is consolidation therapy to prevent relapse.
- Administration: Typically involves regular chemotherapy injections, often given on an outpatient basis, although hospital stays may be needed if symptoms worsen or infections develop.
- Duration: The consolidation phase lasts for several months.
Additional AML Treatments
Radiotherapy
High doses of controlled radiation may be used to:
- Prepare the body for a bone marrow or stem cell transplant
- Treat advanced cases of AML that have spread to the nervous system or brain (uncommon)
Common Side Effects: Hair loss, nausea, and fatigue.
Bone Marrow and Stem Cell Transplants
When chemotherapy is unsuccessful, a bone marrow or stem cell transplant may be considered. The process involves destroying cancerous cells in the bone marrow with high-dose chemotherapy and potentially radiotherapy before introducing donor stem cells through a blood vessel.
- Donor Match: Ideal donors are siblings with a matching tissue type.
- Hospital Care: Transplants require hospital stays due to significant physical strain and potential complications.
Azacitidine
Azacitidine is an option for adults who cannot undergo a stem cell transplant. It’s administered by injection and interferes with cancer cell growth, while also promoting normal blood cell production.
Clinical Trials and New Treatments
Ongoing clinical trials in the UK explore new and experimental AML treatments. Participation in trials may offer access to unlicensed treatments not available in standard care. Discuss available trials and their risks with your care team.
Complications of Acute Myeloid Leukaemia (AML)
Acute Myeloid Leukaemia (AML) can lead to various complications, some stemming from the condition itself and others due to the side effects of treatment. Prompt and effective management is crucial to minimize these complications and improve patient outcomes.
Weakened Immune System
A weakened immune system, or being immunocompromised, is a frequent complication of AML. This vulnerability is due to both the leukaemia itself and the medications used to treat it, which can significantly impair immune function.
- Risk of Infection: Patients are more susceptible to infections, which can become severe or life-threatening. Infections are a leading cause of death in people with AML. However, timely intervention can significantly improve outcomes.
- Preventative Measures:
- Regular use of antibiotics may be recommended to ward off bacterial infections.
- Maintain excellent personal and dental hygiene to reduce exposure to harmful bacteria.
- Avoid contact with people who have infections, even those you were previously immune to, such as chickenpox or measles.
- Stay up-to-date on vaccinations, though vaccines containing live viruses or bacteria (like the MMR and shingles vaccines) are contraindicated.
- Signs of Infection: Immediately report any of the following symptoms to your healthcare team:
- High temperature (fever)
- Headache
- Aching muscles
- Diarrhoea
- Fatigue
Bleeding
People with AML are prone to excessive bleeding and easy bruising due to low levels of platelets (cells responsible for blood clotting). Advanced AML can lead to severe bleeding (haemorrhage) inside the body, which is the second most common cause of death among patients.
- Common Types of Severe Bleeding:
- Intracranial haemorrhage (bleeding inside the skull): Symptoms may include a severe headache, stiff neck, vomiting, and confusion.
- Pulmonary haemorrhage (bleeding inside the lungs): Symptoms may include coughing up blood, breathing difficulties, and a bluish skin tone (cyanosis).
- Gastrointestinal haemorrhage (bleeding inside the stomach): Symptoms can include vomiting blood and passing dark or tar-like stools.
- Emergency Response: If you suspect a haemorrhage, dial 999 immediately and request an ambulance.
Infertility
Infertility can be a side effect of treatments for AML, such as high-dose chemotherapy and radiotherapy. Infertility may be temporary or permanent, depending on treatment intensity and individual circumstances.
- Risk of Infertility: Those at greatest risk are patients receiving high-dose therapy in preparation for a bone marrow or stem cell transplant. Your treatment team can offer an estimation of the likelihood of infertility in your case.
- Preservation Options:
- Men: Sperm banking can preserve fertility.
- Women: Eggs or fertilized embryos may be stored and used later.
- Timing: Since AML progresses rapidly, there may not always be sufficient time to undergo fertility preservation before starting treatment.
Diverticular Disease and Diverticulitis
