Overview
What is Acute Myeloid Leukaemia (AML)?
- AML is a type of cancer that starts in the bone marrow, where new blood cells are made.
- It causes the bone marrow to produce abnormal white blood cells called myeloblasts, which crowd out healthy blood cells.
Who is affected?
- AML can occur at any age but is most common in adults over 60.
- It is rare in children.
Causes and Risk Factors
Why does it happen?
- AML develops when DNA in the bone marrow cells changes (mutates), leading to uncontrolled growth of abnormal cells.
Are certain people more at risk?
- Older adults
- People exposed to high doses of radiation or certain chemicals (like benzene)
- Previous chemotherapy or radiation treatment for another cancer
- Some genetic disorders (e.g., Down syndrome)
- Having other blood disorders (like myelodysplasia)
Symptoms
What are the common signs and symptoms?
- Feeling very tired or weak
- Frequent infections or fevers
- Easy bruising or bleeding (e.g., nosebleeds, bleeding gums, small red spots on the skin)
- Pale skin
- Shortness of breath
- Bone or joint pain
- Swollen gums (less common)
Diagnosis
How is it diagnosed?
- A doctor will start with a physical exam and blood tests if AML is suspected.
What tests are commonly done?
- Full blood count (FBC): Checks levels of red and white blood cells and platelets
- Blood smear: Looks at blood cells under a microscope
- Bone marrow biopsy: Confirms the diagnosis by examining bone marrow cells
- Genetic and molecular tests: Find specific mutations that can guide treatment
- Other tests: Chest X-rays, lumbar puncture (rare), or scans if needed
How is Acute Myeloid Leukaemia (AML) treated?
Treatment for Acute Myeloid Leukaemia (AML) has improved considerably in recent years.
The choice of treatment depends on several factors:
- The patient’s age and general health
- The type of AML
- Genetic and molecular abnormalities found in the leukaemia cells
- Whether the patient is suitable for intensive chemotherapy
- Whether a stem cell transplant may be beneficial
Treatment aims to achieve remission, meaning that leukaemia cells are no longer detectable using standard tests and normal blood cell production can recover.
- Intensive Chemotherapy for Younger and Fitter Adults
For younger adults and medically fit older patients, intensive chemotherapy remains an important treatment option.
A commonly used treatment is called “7+3” chemotherapy.
This consists of:
- Cytarabine: Given continuously for 7 days.
- Daunorubicin or idarubicin: Given for the first 3 days.
This treatment is usually administered in hospital because it causes a temporary but severe reduction in normal blood cells.
Patients may require several weeks of hospitalisation, blood and platelet transfusions, and antibiotics to manage infections.
The initial treatment is called induction chemotherapy. Its aim is to achieve remission.
Once remission is achieved, further treatment called consolidation chemotherapy is usually required to reduce the risk of relapse.
Some patients may subsequently undergo an allogeneic stem cell transplant.
- Newer Treatments: Hypomethylating Agents and Venetoclax
Traditionally, older patients or those unable to tolerate intensive chemotherapy had fewer effective treatment options.
This has changed significantly with the introduction of hypomethylating agents (HMAs) combined with venetoclax.
Hypomethylating agents include:
- Azacitidine
- Decitabine
These medicines help restore more normal control of gene activity in leukaemia cells.
Venetoclax is an oral targeted medicine that blocks a protein called BCL-2.
BCL-2 helps leukaemia cells survive by preventing their natural programmed cell death.
By blocking BCL-2, venetoclax makes leukaemia cells more likely to die.
Azacitidine + Venetoclax
This combination has become an important treatment for older adults and patients who are unsuitable for intensive chemotherapy.
Advantages include:
- High remission rates compared with azacitidine alone
- Improved survival compared with azacitidine alone
- Treatment that can often be delivered partly as an outpatient
- An alternative to conventional intensive chemotherapy
However, this treatment is not without risks.
Patients may develop prolonged low blood counts, infections and other complications. Close monitoring and dose adjustments are often necessary.
Treatment is generally given in repeated cycles and continued while it remains effective and tolerable.
Importantly, age alone does not determine treatment. Some older adults may still benefit from intensive chemotherapy, while selected younger patients may receive less-intensive treatment.
Recent studies are also investigating azacitidine plus venetoclax as an alternative to intensive chemotherapy in selected medically fit patients.
- Targeted Treatment Based on Genetic Mutations
Modern AML treatment increasingly depends on the genetic abnormalities found in the leukaemia cells.
Molecular testing is therefore an essential part of the initial assessment.
Examples of targeted treatments include:
- FLT3 inhibitors: Midostaurin or quizartinib may be added to intensive chemotherapy for suitable patients with FLT3 mutations. Gilteritinib is an important option in relapsed or refractory FLT3-mutated AML.
- IDH1 inhibitors: Ivosidenib may be used in selected patients with an IDH1 mutation, including in combination with azacitidine.
- IDH2 inhibitors: Enasidenib may be considered in certain patients with IDH2-mutated AML, particularly after relapse.
- Other targeted medicines: New treatments directed against specific molecular abnormalities are being developed and evaluated in clinical trials.
Not every patient will benefit from these medicines. Their use depends on the genetic findings, treatment setting and drug availability.
- Allogeneic Stem Cell Transplantation (Bone Marrow Transplant)
For selected patients, allogeneic haematopoietic stem cell transplantation offers an important opportunity for long-term remission and potential cure.
This involves replacing the patient’s diseased bone marrow with healthy blood-forming stem cells from a compatible donor.
The donor may be:
- A matched brother or sister
- A matched unrelated donor
- A partially matched family member (haploidentical donor)
Before transplantation, patients receive chemotherapy, sometimes with radiotherapy, to prepare the bone marrow for the donor cells.
An important benefit of transplantation is the graft-versus-leukaemia effect.
This occurs when immune cells from the donor recognise and attack remaining leukaemia cells, helping to prevent relapse.
Who should consider transplantation?
Allogeneic transplantation is particularly important for patients with:
- Intermediate-risk or adverse-risk AML
- Certain high-risk genetic or molecular abnormalities
- Persistent measurable residual disease (MRD) after treatment
- AML that has relapsed but subsequently achieved another remission
Patients with favourable-risk AML may not require transplantation during their first remission.
The decision depends on disease risk, response to treatment, age, general health and donor availability.
Transplantation carries significant risks, including infections, graft-versus-host disease and treatment-related complications.
Not every patient with AML requires a transplant. The benefits must be weighed carefully against the risks.
- Supportive Care During Treatment
Regardless of the treatment chosen, supportive care is essential.
This may include:
- Red blood cell transfusions for anaemia
- Platelet transfusions to prevent or treat bleeding
- Antibiotics and antifungal medicines to prevent or treat infections
- Medicines to control nausea and other side effects
- Nutritional support
- Regular blood tests and bone marrow examinations
Patients receiving chemotherapy or venetoclax-based treatment require close monitoring because their immune systems may become severely weakened.
- Monitoring Treatment Response
Doctors assess treatment response through blood tests and bone marrow examinations.
Increasingly, sensitive tests are used to detect measurable residual disease (MRD).
MRD testing can identify very small numbers of remaining leukaemia cells that may not be visible under a microscope.
These results can help doctors assess relapse risk and decide whether further chemotherapy or stem cell transplantation is appropriate.
Dietary Advice
Specific dietary recommendations:
- Eat a balanced diet with enough calories, protein, fruits, and vegetables to support recovery.
- If you have a low white blood cell count, follow a “neutropenic diet” (avoid raw/undercooked foods to reduce infection risk).
Nutrition tips to support treatment or symptom control:
- Eat small, frequent meals if you have poor appetite or nausea
- Stay hydrated (plenty of fluids)
- Manage mouth sores with soft, non-acidic foods
Common supplements (if applicable):
- Do not take supplements without consulting your doctor – some can interfere with treatment
Food safety or drug-food interactions:
- Wash fruits/vegetables thoroughly
- Avoid unpasteurized dairy, raw eggs, sushi, or undercooked meats
- Some medications may interact with grapefruit or herbal supplements – always check with your doctor or pharmacist
Living with the Condition
Managing daily activities:
- Rest when you need to, but try to stay as active as possible
- Accept help from family and friends
Exercise, lifestyle, and emotional well-being:
- Light activities (walking, stretching) are often helpful
- Support groups, counselling, or talking with others living with AML can provide emotional support
- Take care of your mental health; don’t hesitate to seek help if feeling overwhelmed
Tips for long-term monitoring and follow-up:
- Attend all scheduled follow-up appointments
- Monitor for new or worsening symptoms and inform your healthcare team
- Stay updated on vaccinations (ask your doctor about flu or pneumonia vaccines)
FAQs
- Is AML curable? Many people can achieve remission with treatment, but cure rates depend on age, general health, and specific genetic factors. Your doctor can discuss your individual outlook.
- Can AML come back after treatment? AML can relapse, so close follow-up is needed. New treatments are available even for relapsed AML.
- Will I lose my hair during treatment? Chemotherapy can cause hair loss, but hair usually grows back after treatment ends.
- Can I go back to work or school? This depends on your health and treatment plan. Some people can return part-time during or after treatment.
- Should my family be tested for AML? Most cases are not inherited, but some rare genetic forms exist. Your doctor can advise if family screening is needed.
Call to Action
When to contact a doctor:
- If you have fever, bleeding, new bruising, severe tiredness, shortness of breath, or any symptoms that worry you
Other Information Resources
This information is for educational purposes only and not a substitute for medical advice. Always discuss your specific situation with your healthcare provider.