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Leukemia - Acute Myeloid - AML - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Adult Acute Myeloid Leukemia. To see other pages, use the menu. Think of that menu as a roadmap to this final full guide.

Leukemia is a cancer of the blood. Leukemia begins when healthy blood cells change and grow out of control. Acute myeloid leukemia (AML) is a disorder of the process that normally produces neutrophils, red blood cells, and/or platelets, which are types of healthy blood cells. AML may sometimes be called acute myelogenous leukemia, acute myelocytic leukemia, or acute nonlymphocytic leukemia. Unlike chronic leukemia, acute leukemia develops quickly and generally needs immediate treatment. AML occurs in people of all ages but is most common in adults older than 65.

About neutrophils

Neutrophils are normal white blood cells with granules inside the cell. They are also sometimes called mature granulocytes. Neutrophils fight infections caused by bacteria and other organisms. Mature neutrophils grow from immature white blood cells, also called progenitors, in a process called differentiation. The production of mature neutrophils usually is highly regulated. For example, the body rapidly makes more neutrophils during an infection and returns to a regular level of production when the infection is controlled.

About AML

In AML, damage to the genetic material or DNA in the blood-forming cells cause problems with the blood cell development. This type of damage is called an acquired mutation. When blood cells do not develop as expected, it causes a build-up of many immature cells called myeloblasts or blasts. Blasts do not act like fully developed, healthy blood cells and do not help a person’s immune system work. These acquired mutations and the large number of blasts also reduces the number of healthy blood cells, including:

  • Red blood cells, which carry oxygen

  • Platelets, which help the blood to clot

Therefore, people with AML are likely to have the following symptoms:

  • Anemia from too few red blood cells

  • Infections because they do not have enough mature neutrophils

  • Easy bruising or bleeding because of a low numbers of platelets

AML is usually found in the blood and bone marrow, the spongy, red tissue in the inner part of the large bones, but it can sometimes also spread to other parts of the body, such as the brain, skin, and gums. Occasionally, AML cells can form a solid tumor called a myeloid sarcoma or chloroma that can develop anywhere in the body.

Normal peripheral blood with two neutrophils

Normal peripheral blood with two neutrophils
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AML Disease

AML disease
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These images used with permission by the College of American Pathologists.

This section is about AML in adults. Read about childhood AML.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will find information about how many people are diagnosed with AML each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu.

This year, an estimated 19,950 people of all ages (11,130 men and boys and 8,820 women and girls) in the United States will be diagnosed with AML. AML is the second most common type of leukemia diagnosed in both adults and children.

An estimated 10,430 deaths (5,950 men and boys and 4,480 women and girls) from AML will occur this year.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with AML is approximately 26%.

However, it is important to note that survival depends on several factors, including biologic features of the disease and, in particular, a patient’s age (see Subtypes for more information). Although AML is a serious disease, it is treatable and often curable with chemotherapy with or without a stem cell transplant (see the Treatment Options section).

It is important to remember that statistics on how many people survive this type of cancer are an estimate. The estimate comes from data based on thousands of people with this cancer in the United States each year. So, your own risk may be different. Doctors cannot say for sure how long anyone will live with AML. Also, experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts and Figures 2016, and from the ACS website.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Or, use the menu to choose another section to continue reading this guide. 

Leukemia - Acute Myeloid - AML - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing AML. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

Although the cause of AML is not known, several factors are associated with an increased risk of the disease. The following factors may raise a person’s risk of developing AML:

  • Age. AML is more common in older adults, but it occurs at all ages. About half of people with AML are older than 65 when diagnosed.

  • Smoking. The risk of AML has been linked to exposure to tobacco smoke, probably along with other causes. 

  • Genetic disorders. Increasingly, researchers are finding that leukemia may run in a family due to inherited gene mutations. AML occurs more often in people with the following inherited disorders:

  • High doses of radiation. People who have been exposed to high levels of radiation, such as long-term survivors of atomic bombs, may be more likely to develop AML. Electromagnetic fields generated by high-voltage electrical power lines have not been shown to cause AML.

  • Previous cancer treatment. People who have received chemotherapy and/or radiation therapy for other types of cancer, such as breast cancer, ovarian cancer, and lymphoma, have a higher risk of developing AML in the years following treatment.

  • Chemicals. Long-term contact with products containing the chemical benzene, found in petroleum, cigarette smoke, and industrial workplaces, raises the risk of AML. However, exposure to industrial solvents and hair dyes has not been proven to increase a person’s risk of AML.

  • Other bone marrow disorders. People who have other bone marrow diseases including myeloproliferative disorders can develop AML over time. Myelo- means bone marrow and proliferative means too much. These conditions include:

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

People with AML may experience the following symptoms or signs. Sometimes, people with AML do not have any of these symptoms. Or, the cause of a symptom may be another medical condition that is not leukemia.

  • Fatigue

  • Weakness

  • Pale skin

  • Easy bruising or bleeding that does not stop easily

  • Weight loss

  • Fever

  • Bone or abdominal pain

  • Difficulty breathing and/or shortness of breath

  • Frequent infections or infections that do not go away

  • Swollen lymph nodes or glands

  • Swollen or bleeding gums

  • Chest pain

  • Dizziness

  • Unusually long menstrual cycle for women

  • Skin nodules

  • Red, pin-head sizes spots on the skin

  • Wounds or sores that do not go away

  • Headache

  • Blurred vision

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If leukemia is diagnosed, relieving symptoms remains an important part of care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose leukemia. They also do tests to find out the subtype (see Subtypes). Doctors may also do tests to learn which treatments could work best. For example, imaging tests can show more information about the cause of your symptoms. Imaging tests show pictures of the inside of the body.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing AML, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of leukemia suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

The following tests may be used to diagnose AML:

  • Blood tests. To diagnose AML, a doctor will do blood tests to count the number of white blood cells and to see if they look abnormal under the microscope. Special tests called flow cytometry, or immunophenotyping, and cytochemistry are sometimes used to distinguish AML from other types of leukemia and to determine the exact subtype of AML.

  • Bone marrow aspiration and biopsy. These 2 procedures are similar and often done at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. The skin in that area is numbed with medication beforehand, and other types of anesthesia (medication to block the awareness of pain) may be used. If blood tests (see above) indicate AML, it is better to have the bone marrow aspiration and biopsy at the hospital where treatment will be given so the test does not need to be repeated.

  • Genomic testing. Your doctor may recommend running laboratory tests on the leukemia cells to identify specific genes, proteins, chromosome changes, and other factors unique to the leukemia. Chromosome studies called cytogenetics are used to find genetic changes in the AML blasts. In addition, several specific genetic mutations in the AML cells have been found that can help determine a person’s prognosis, or chance of recovery. These molecular analyses are now being done more often when AML is first diagnosed. Results of these tests will help decide your treatment options (see the Treatment Options section).

  • Imaging tests. A computed tomography (CT or CAT) scan is a test that creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A magnetic resonance imaging (MRI) is a test that uses magnetic fields, not x-rays, to produce detailed images of the body. A special dye called a contrast medium is given before these scans to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. These tests may be used to learn more about the cause of symptoms or to help diagnose infections in patients with AML. They are not regularly used to find out how widespread the AML is because the disease has often spread throughout the bone marrow when it is first diagnosed.

  • Lumbar puncture, also called a spinal tap. A lumbar puncture is a procedure in which a doctor uses a needle to take a sample of cerebral spinal fluid (CSF) to look at the make up of the fluid and to find out is it contains leukemia cells or blood. CSF is the fluid that flows around the brain and spinal cord. Doctors generally give an anesthetic to numb the lower back before the procedure. The CSF is then examined under the microscope to look for AML cells.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is AML, these results also help the doctor describe the disease; this is called subtyping.

The next section in this guide is Subtypes. It explains the way that doctors describe AML. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Subtypes

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will learn about how doctors describe AML. This is called the subtype. To see other pages, use the menu.

There are different ways to classify the subtypes of AML. Although all subtypes cause decreases in normal blood cell levels, different types of AML are associated with specific symptoms and problems. In addition, each subtype can behave differently after treatment.  


AML is first described by its morphology, or what the cancerous cells look like under the microscope. AML is classified by the type of normal, immature white blood cell it most closely resembles.  

Most patients with AML have a subtype called myeloid leukemia, which means the cancer is in the cells that normally produce neutrophils. Other patients have a type of AML called monoblastic or monocytic leukemia. In monocytic leukemia, the cells look like white blood cells called monocytes. Leukemia cells can also be a mixture of myeloblastic and monocytic cells.

Sometimes AML seems to come from cells that produce red blood cells, called erythroid, or platelets, called megakaryocytic. Acute promyelocytic leukemia (APL) is a unique subtype of AML where the cancer cell stops maturing when the cell is at a stage called the promyelocyte or progranulocyte stage. APL is associated with a translocation between chromosomes 15 and 17 [t(15;17)].

The classification system from the World Health Organization (WHO) includes these major groups:

  • AML with recurrent genetic abnormalities, meaning with specific chromosomal changes

  • AML with multilineage dysplasia, or abnormalities in how the blood cells look

  • AML, related to therapy that is damaging to cells, also called therapy-related myeloid neoplasm

  • AML that is not otherwise categorized

The French-American-British (FAB) classification is an older system for describing AML, but it is still commonly used and is listed below for reference.   

M0: Myeloblastic without differentiation
M1: Myeloblastic with little or no maturation
M2: Myeloblastic with maturation
M3: Promyelocytic
M4: Myelomonocytic
M4eo: Myelomonocytic with eosinophils
M5a: Monocytic without differentiation (monoblastic)
M5b: Monocytic with differentiation
M6: Erythroleukemic
M7: Megakaryocytic


AML is also classified by the cytogenetic, or chromosome, changes found in the leukemia cells. Sometimes the doctor can find these changes by looking at the chromosomes in dividing cells under the microscope. Other changes can be found only with very specific molecular tests that can recognize very small changes in the DNA.

Certain chromosomal changes are closely matched with the morphology of the AML cells. More importantly, the chromosomal changes help doctors determine the best treatment options because these changes can sometimes predict how well intensive treatment will work. Chromosomal changes are commonly grouped according to the likelihood that treatment will work against the subtype of AML.

All chromosomes are numbered from 1 to 22. And, sex chromosomes are called “X” or “Y.” The letters “p” and “q” refer to the “arms” or specific areas of the chromosome. Some of the types of genetic changes found in AML include:

  • A translocation, which means that a chromosome breaks off and reattaches to another chromosome

  • Extra copies of a chromosome

  • A deletion of a chromosome

Some of the most common chromosomal changes are grouped as follows:

  • Favorable. Chromosomal changes associated with more successful treatment include abnormalities of chromosome 16 at bands p13 and q22 [t(16;16)inv(16)(p13q22)], a translocation between chromosomes 8 and 21 [t(8;21)].

  • Intermediate. Changes associated with a less favorable prognosis include normal chromosomes, where no changes are found and a translocation between chromosomes 9 and 11 [t(9;11)]. Many other subtypes are considered part of this group, particularly those with 1 or more specific molecular changes. Sometimes, extra copies of chromosome 8 or trisomy 8 may be classified as intermediate risk over unfavorable (see below).

  • Unfavorable. Examples of chromosomal changes that are associated with less successful treatment or with a low chance of curing the AML include extra copies of chromosomes 8 or 13 [for example, trisomy 8 (+8)], deletion of all or part of chromosomes 5 or 7, complex change on many chromosomes, and changes to chromosome 3 at band q26.

In general, the favorable changes occur more commonly in younger patients, while the unfavorable changes are more common in patients older than 60. How well treatment works still varies widely in each of these groups. Treatment is successful in the long term for 50% to 60% of patients younger than 60 with AML that is classified as favorable and for less than 10% of patients younger than 60 with AML that is classified as unfavorable. Prognosis in patients older than 60 years of age is significantly worse. How well treatment works also depends on other factors, including the patient’s age and the number of white blood cells. It is not possible to predict exactly the likelihood of successful treatment for a person with AML.

Molecular changes

Mutations in genes that are too small to be seen with a microscope and cannot be found with cytogenetic tests have been found using tests called molecular assays. For example, patients with changes in the NPM1 or CEBPalpha genes have a better long-term outcome, while chemotherapy (see the Treatment Options section) does not work as well for patients with changes in the FLT3 gene. Therefore, testing for these changes at diagnosis helps determine a patient’s treatment options. 

Recurrent AML

Recurrent or relapsed AML is cancer that has come back after treatment. If the AML does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Information about the subtype will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat people with AML. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for this type of leukemia. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the most common treatment options for AML are listed below. Treatment options and recommendations depend on several factors, including the subtype, morphology, and cytogenetics of AML (see Subtypes), possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

The most successful treatment for AML depends on the results of the first treatment, so it is important for patients to have their first treatments at a center experienced with AML.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Intensive chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. The drugs get into the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Or, it is given by a hematologist, a doctor who specializes in treating blood disorders.

Chemotherapy is the primary treatment for AML. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include:

  • An intravenous (IV) tube placed into a vein using a needle. When chemotherapy is given by IV, it may be given into a larger vein or a smaller vein, such as in the arm. When it is given into a larger vein, a central venous catheter or port may need to be placed in the body.

  • An injection into the cerebral spinal fluid

  • In a pill or capsule that is swallowed (orally)

  • An injection under the skin, called a subcutaneous injection

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time. Several drugs are used to treat AML, which are discussed below.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy by phase

Chemotherapy for AML can be divided into 3 phases: induction, post-remission, and consolidation.

  • Induction therapy. This is the first period of treatment after diagnosis. The goal of induction therapy is a complete remission (CR). A person has a CR when:

    • Blood counts have returned to normal

    • Leukemia cannot be found in a bone marrow sample when examined under the microscope

    • There are no longer any signs and symptoms of AML

    The combination of cytarabine (Cytosar-U) given over 4 to 7 days and an anthracycline drug, such as daunorubicin (Cerubidine) or idarubicin (Idamycin), given for 3 days is used most often. Patients may also be given hydoxyurea (Droxia, Hydrea) to help lower white blood cell counts. In addition to killing leukemia cells, these drugs also damage healthy cells, increasing the risk of infection and bleeding (see below). Most patients will need to stay in the hospital for 3 to 5 weeks during induction therapy before their blood counts return to normal. Sometimes, 2 rounds of therapy are needed to achieve a CR. Approximately 75% of younger adults with AML and about 50% of patients older than 60 achieve a CR after treatment. 

    Some older adults may not be able to have induction therapy with the standard drugs. The drugs decitabine (Dacogen), azacitidine (Vidaza), and clofarabine (Clolar) may be used instead. A clinical trial is also an option.

  • Post-remission therapy. After induction therapy, a variety of different drugs are used to destroy AML cells that remain but cannot be detected by medical tests. AML will almost certainly recur if no further treatment is given after a CR. For some patients, bone marrow/stem cell transplantation (see below) is recommended as part of post-remission therapy.

  • Consolidation chemotherapy. Younger adults in remission are commonly given 2 to 4 rounds of high-dose cytarabine or other intensive chemotherapy at monthly intervals, while several different regimens are used for older patients. Although chemotherapy is usually given in the hospital, most of the recovery time can be spent at home. A stem cell transplantation is often recommended as consolidation therapy for younger patients in whom cytogenetic or molecular studies predict a poorer outcome using chemotherapy alone.

  • Stem cell transplantation/bone marrow transplantation. A stem cell transplant is a medical procedure in which bone marrow that contains leukemia is destroyed and then replaced by highly specialized cells, called hematopoietic stem cells, that develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is the stem cells in the blood that are typically being transplanted, not the actual bone marrow tissue.

Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the type of cancer, results of any previous treatment, and patient’s age and general health.

There are 2 types of stem cell transplantation depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). ALLO uses donated stem cells, while AUTO uses the patient’s own stem cells. ALLO transplants are generally used for AML.

The goal is to destroy all of the cancer cells in the marrow, blood, and other parts of the body using high doses of chemotherapy and/or radiation therapy and then allow replacement blood stem cells to create healthy bone marrow. Learn more about the basics of stem cell and bone marrow transplantation.

Side effects of chemotherapy

Chemotherapy for AML attacks rapidly dividing cells, including those in healthy tissues, such as the hair, lining of the mouth, intestines, and bone marrow. People with AML receiving chemotherapy may lose their hair, develop mouth sores, or have nausea and vomiting. Hair will regrow after treatment is finished, and effective drugs help prevent and control nausea and vomiting. The side effects of chemotherapy may be different depending on the drugs used. Patients are encouraged to talk with their doctors about short-term and long-term side effects before treatment begins.

Because of the effect on healthy blood cells in the bone marrow, chemotherapy used for AML will lower the body’s ability to fight infection for a short time, and increased bruising, bleeding, and fatigue may be common. People with AML often receive antibiotics to prevent and treat infections and will need transfusions of red blood cells and platelets throughout chemotherapy. Chemotherapy may also affect the patient’s fertility, or ability to have a child in the future. Patients concerned about this are encouraged to talk with a fertility specialist before treatment begins.

Acute promyelocytic leukemia (APL) treatment

The treatment of the APL subtype of AML is very different. This subtype is very sensitive to the effects of all-trans retinoic acid (ATRA), a drug that is similar to vitamin A and is given by mouth. People with the APL subtype who receive a combination of ATRA and chemotherapy (see above) with idarubicin or daunorubicin are very likely to have a CR. Occasionally, the drug cytarabine may also be used. Arsenic trioxide (Trisenox) is another drug that works well for APL, either during induction therapy alone or in combination with ATRA during post-remission therapy or for APL that has come back after treatment.

Mild to severe bleeding is a common symptom of APL, and patients with this subtype often need many platelet and blood transfusions during initial treatment. Compared with other subtypes of AML where maintenance therapy is not used, some patients with APL benefit from use of ATRA for 1 to 2 years after the initial treatment.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation therapy is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen usually consists of a specific number of treatments given over a set period of time. Because AML is found throughout the blood, radiation therapy is generally used only when leukemia cells have spread to the brain or to shrink a myeloid sarcoma. A myeloid sarcoma is a mass of tissue found in only a part of the body.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.

Getting care for symptoms and side effects

Leukemia and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the disease, an important part of care is relieving a person’s symptoms and the side effects of treatment. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the leukemia and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the leukemia, such as chemotherapy or radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Refractory AML

If leukemia is still present after initial treatment, the disease is called refractory AML. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your treatment plan chosen.

Your treatment plan may include new drugs being tested in clinical trials. An ALLO stem cell transplant should also be considered. Palliative care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of refractory leukemia is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group. 

Remission and the chance of recurrence

A remission is when the leukemia cannot be detected in the body, there are no symptoms, and a patient’s blood counts are normal. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the leukemia returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the disease does return. Learn more about coping with the fear of recurrence.

If the leukemia does return after the original treatment, it is called recurrent or relapsed leukemia. When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as chemotherapy, stem cell transplantation, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent leukemia. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.  

The treatment for recurrent AML often depends on the length of the initial remission. If the AML comes back after a long remission, the original treatment may work again. If the remission was short, then other drugs are used, often through a clinical trial. An ALLO stem cell transplant may be the best option for patients whose leukemia has come back after initial treatment. However, many drugs and other approaches are being researched in clinical trials and these may provide other treatment options.

People with recurrent leukemia often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from leukemia is not always possible. If the leukemia cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and it may be difficult to discuss because the advanced leukemia is incurable. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients with advanced leukemia who have no more effective treatment options available may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with AML. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating AML. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with AML.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for AML, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for AML. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about AML and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about AML, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Most cancer centers are actively involved in clinical trials focused on increasing the number of people cured of AML. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Understanding AML biology. Research on the biology of AML is ongoing to learn more about how leukemia develops and to improve its treatment, particularly for older patients.

  • New drugs and treatment regimens. Researchers are looking at the use of existing drugs given in different doses and schedules, as well as new drugs. Specific research includes the use of drugs called hypomethylating therapy, such as azacitidine or decitabine. A new drug combination is also being researched called CPX-351, which combines the drugs cytarabine and daunorubicin.

  • Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Researchers are studying ways to block how specific genetic changes found in AML cells affect the body. For example, about 30% of patients with AML have changes in the FLT3 gene, which can increase the growth of AML cells. Quizartinib is a drug that stops the changed FLT3 gene from working that is being tested in clinical trials. Other targeted therapies are being researched that stop AML cells from becoming resistant to chemotherapy when the chemotherapy stops working. Specific targeted therapy drugs being researched include midostaurin, lenalidomide (Revlimid), sorafenib (Nexavar), glasdegib, venetoclax, and other drugs that are targeted to specific gene mutations such as IDH1 and IDH2, c-KIT and RAS.

  • Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the leukemia. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Researchers are specifically looking at vaccines and the use of antibodies directed against the AML cells. Researchers are also looking at adoptive immunotherapy techniques. This type of immunotherapy involves changing a person’s white blood cells in a laboratory to increase their ability to fight the tumor. The changed cells are given back to the patient.

  • Stem cell/bone marrow transplantation. Different ways to make stem cell transplantation safer, easier, and more effective are also being studied (see Treatment Options).

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current AML treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding AML explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that AML and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every treatment for leukemia can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of leukemia. This can make it hard to predict how you will feel during treatment.

As you prepare to start treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for AML are described within the Treatment Options section. Learn more about side effects of leukemia and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the leukemia’s subtype, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after an AML diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Treatment can be expensive. It is often a big source of stress and anxiety for people with AML and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with AML

Family members and friends often play an important role in taking care of a person with AML. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of AML.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care and it explains the importance of check-ups after treatment for AML is finished. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will read about your medical care after treatment is completed, and why this follow-up care is important. To see other pages, use the menu.

Care for people diagnosed with AML doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the leukemia has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Leukemia recurs because small areas of leukemia cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the subtype of AML originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the subtype of AML, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the subtype of AML, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your care for AML will lead your follow-up care, be sure to share your treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a diagnosis of AML. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a diagnosis of AML. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having leukemia. This is because it is different for everyone.  

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after the diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the health care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with leukemia, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from AML are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. This booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your health care team. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What is my diagnosis? What does it mean?

  • What subtype of AML do I have?

  • Do I need to start treatment right away?

  • Can you recommend a leukemia specialist?

  • Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

  • Where is the best place for me to receive treatment?

  • What are my options for treatment?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the leukemia, manage the symptoms or side effects, or both?

  • How likely is it that my AML will go into remission?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before treatment begins?

  • How will the treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • If I’m worried about managing the costs of medical care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call for questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having chemotherapy or a stem cell transplant

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • How long will treatment last overall?

  • Will I need to stay in the hospital during treatment? Why and when?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the AML will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

Leukemia - Acute Myeloid - AML - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about care and treatment. This is the final page of Cancer.Net’s Guide to Adult Acute Myeloid Leukemia. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of leukemia, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Adult Acute Myeloid Leukemia. Use the menu to select another section to continue reading this guide.