Acute Myeloid Leukaemia

Overview

Acute Myeloid Leukaemia (AML) is a type of cancer that starts in the bone marrow — the spongy tissue inside your bones where blood cells are made. It causes the body to make too many abnormal white blood cells called myeloblasts. These cells do not work properly and crowd out healthy red blood cells, white blood cells, and platelets. The word 'acute' means it grows quickly and needs urgent treatment.

No, AML is uncommon. It represents about 1% of all cancers. It is the most common acute leukaemia in adults, but most people are diagnosed after age 65.

AML can affect anyone, but it is most often diagnosed in older adults, usually over 65. It is slightly more common in men and in people who have previously had chemotherapy or radiation therapy, or who have certain genetic conditions. It can also occur in children, though it is rare.

Symptoms

Common symptoms

• Feeling tired or weak even after rest
• Shortness of breath during light activity
• Pale or washed-out skin
• Frequent or persistent infections
• Fever or night sweats
• Bruising or bleeding easily, such as frequent nosebleeds or bleeding gums
• Small red or purple spots on the skin (petechiae)
• Bone or joint pain
• Unexplained weight loss
• Swollen, painless glands in the neck, armpit, or groin

Symptoms in children

• Lack of energy and irritability
• Pale skin and weakness
• Fever that doesn't go away
• Frequent infections
• Easy bruising or small red spots
• Bone or joint pain, or a limp

Symptoms in older adults

• Extreme tiredness and weakness
• Shortness of breath on exertion
• Frequent or severe infections
• Unexplained bruising or bleeding
• Confusion or difficulty thinking clearly
• Loss of appetite and weight loss

Causes

Main causes

• The exact cause is unknown, but AML begins when the DNA (genetic material) inside certain bone marrow cells becomes damaged and the cells grow out of control.
• Most cases happen with no known cause.

Risk factors

• Age over 65
• Previous cancer treatment with chemotherapy or radiation therapy
• Certain blood disorders, such as myelodysplastic syndromes
• Exposure to high doses of radiation, such as from an atomic bomb accident, or industrial chemicals like benzene
• Smoking tobacco
• Down syndrome or other inherited genetic disorders
• Being male

When to see a doctor

See a doctor urgently if:

• If you have new, easy bruising or bleeding—especially bleeding from the gums or nose—along with a fever or infection, see a doctor today.
• If you feel extremely tired, short of breath, or have a persistent fever, seek urgent medical attention.

Book a routine appointment if:

• If you have had fatigue, weight loss, fever, or repeated infections for more than a few days, make a routine appointment.
• If you notice swelling in your glands or joint and bone pain, check with your GP.

Diagnosis

If your GP suspects leukaemia, you will be referred to a haematologist—a specialist in blood disorders—for blood tests. A full blood count will be checked, and if the results look abnormal, a bone marrow biopsy will be done to confirm the diagnosis.

Tests that may be done

• Full blood count and blood film (looking at blood cells under a microscope)
• Bone marrow biopsy (taking a small sample of marrow from the hip bone to look for leukaemia cells)
• Flow cytometry and genetic tests to find the specific type of AML and help plan treatment
• Imaging tests like a chest X-ray or CT scan to check for spread
• Lumbar puncture (spinal tap) only if there are symptoms suggesting leukaemia in the spinal fluid

What to expect at your appointment

You will be seen at a specialist cancer centre or haematology unit. There will be many blood tests and possibly a physical exam. A bone marrow biopsy is performed with local anaesthetic and is usually uncomfortable rather than painful. It takes a few days to get results. Once a diagnosis is confirmed, treatment starts quickly, usually within a few days.

Treatment

Treatment depends on the exact type of AML, your age, and your overall health. It is usually intensive because AML grows quickly. The main treatment is chemotherapy, often combined with targeted drugs. Some people may receive a stem cell transplant after their leukaemia is in remission. You will be supported by a multidisciplinary team including nurses, pharmacists, dietitians, and social workers.

Self-care at home

• Follow your chemotherapy and medicine schedule exactly—do not skip appointments.
• Wash your hands often and avoid people who are sick to reduce the risk of infection.
• Get plenty of rest, but try to be gently active when you feel well.
• Ask about vaccinations, especially flu and COVID-19 boosters. Some live vaccines are not safe during treatment.
• Talk to your care team about any symptoms, such as pain or nausea.

Medical treatments

In general, treatment includes: induction chemotherapy given in hospital to try to get rid of the leukaemia cells; consolidation chemotherapy (given after remission) to destroy any remaining leukaemia cells; targeted therapy that uses drugs to block specific proteins promoting cancer cell growth; and in selected cases, a stem cell transplant—replacing unhealthy bone marrow with donor stem cells. A doctor will decide the best plan for you, and you can ask about clinical trials. Radiotherapy is sometimes used for certain situations.

When is surgery considered?

Surgery is not a standard treatment for AML. Occasionally, a central venous catheter (a small tube inserted into a large vein) may be placed during a minor procedure to give chemotherapy and draw blood—but this is not a treatment for the leukaemia itself.

Living with this condition

AML treatment is intense and can last several months. You will likely have frequent hospital visits, blood tests, and transfusions. It is important to let others help with daily tasks and to keep a record of appointments and medications. Talk to your team about sick leave and financial support.

Lifestyle tips

• Prioritise rest and sleep; your body needs energy for recovery.
• Keep a simple daily routine, with short walks or light activity if you feel up to it.
• Avoid exposure to infections: wash hands frequently, avoid crowded indoor spaces when your white blood cell count is low, and stay away from people who are unwell.
• Stop smoking and limit alcohol while in treatment—ask your doctor about safe levels.

Diet and exercise

Eat a balanced diet with enough protein and calories to support recovery. Your hospital can arrange a talk with a dietitian if you have a poor appetite or trouble eating. Gentle exercise such as short walks or stretches can help maintain muscle strength and mood. Always ask your specialist before starting new exercise during treatment.

Mental health and emotional wellbeing

A diagnosis of AML can cause stress, anxiety, fear, and sadness. It is completely normal to feel overwhelmed. Talk about your feelings with your care team, family, or a counsellor. Many hospitals have psychologists or mental health nurses who specialise in cancer support. If you feel you cannot cope or have thoughts about harming yourself, contact your local emergency number immediately.

Prevention

Most cases of AML cannot be prevented because the cause is unknown. You can reduce your risk by not smoking, avoiding workplace chemicals like benzene, and maintaining a healthy lifestyle. Avoid unnecessary or high-dose radiation exposures.

Vaccines

There is no vaccine that prevents AML. But staying up to date with recommended vaccinations, such as flu and COVID-19, can help you avoid infections. However, if you are having cancer treatment, ask your doctor which vaccines are safe—some live vaccines may not be given while your immune system is weak.

Screening programmes

There is no routine screening test for AML in the general population. People at higher risk, such as those with myelodysplastic syndromes or inherited blood disorders, may be monitored more closely with regular blood tests.

Complications

If left untreated

• Severe, life-threatening infections due to low white blood cell counts
• Excessive bleeding and internal bleeding due to low platelets
• Anaemia causing severe fatigue, breathlessness, and heart problems
• Leukaemia cells may spread to other organs, causing swelling and failure
• Without treatment, AML can worsen rapidly and lead to death within weeks or months

Long-term outlook

With prompt treatment, about 4 in 10 adults with AML are cured, and many more achieve remission. Younger people and those with certain genetic types have higher cure rates. Treatment is hard but many people recover and return to a good quality of life. Even if AML comes back, further treatments are available. Newer therapies and transplants are improving survival. Talk to your oncologist about what your outlook means for you—every case is different.

Find support

International organisations

• Leukaemia & Lymphoma Society ↗

Local organisations

• Blood Cancer UK ↗ · United Kingdom

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