Understanding Acute Myeloid Leukemia: Symptoms and Treatment Options

Understanding Acute Myeloid Leukemia: Symptoms and Treatment Options

Acute myeloid leukemia (AML) is a serious illness that begins in the bone marrow, the soft center of our bones where blood cells are made. But instead of making healthy blood cells, the marrow produces abnormal ones that don’t work properly. These abnormal cells can crowd out red blood cells, white blood cells, and platelets, which are all important for carrying oxygen, fighting infections, and stopping bleeding.

Imagine feeling tired all the time, bruising easily, or getting frequent infection, these can be early signs of acute myeloid leukemia. Yet, many people may ignore them or blame them on stress or a simple cold. What if a young adult notices that their fatigue isn’t improving even with rest? Or an older adult starts bleeding from the gums without reason? These real scenarios are why taking persistent, unexplained symptoms seriously is important.

How does acute myelogenous leukemia differ from other types of leukemia? Or how quickly does it progress? The answer is, it can move fast, and treatment often needs to begin quickly after diagnosis. 

What is Acute Myeloid Leukemia?

Acute myeloid leukemia (AML) is a fast-growing type of blood cancer that starts in the bone marrow, the area inside your bones where new blood cells are made. AML begins when immature white blood cells, known as myeloblasts, start growing out of control. 

These abnormal cells don’t function like normal white blood cells and crowd out healthy blood cells, including red blood cells and platelets. This disruption in the balance of cells can quickly lead to serious symptoms such as anemia, bleeding, infections, or fatigue.

AML is also called acute myelogenous leukemia, acute myeloblastic leukemia, or acute nonlymphocytic leukemia. While AML mostly affects older adults, it can occur at any age—even in children or young adults.

How AML Affects the Blood and Bone Marrow

In healthy individuals, bone marrow cells grow in a controlled manner. These cells mature into red blood cells, white blood cells, or platelets. But in acute myeloid leukemia, this process breaks down. Instead of developing into mature blood cells, the cells remain stuck in an early stage and multiply quickly. These abnormal blood cells do not perform their normal roles. Over time, they build up in the blood and bone marrow, making it hard for the body to produce enough healthy blood cells.

For example, if there aren’t enough red blood cells, a person may feel weak or dizzy. A lack of platelets can cause easy bruising or bleeding. If white blood cells are low or dysfunctional, the immune system can’t fight infections well. A person with AML might suddenly start getting fevers or infections that don’t go away.

Doctors often use a bone marrow biopsy or bone marrow aspiration to look at what's happening inside the bone marrow and confirm an AML diagnosis. Early detection matters because the disease can progress quickly.

Difference Between AML and Other Leukemias

Leukemia isn’t just one disease. It includes several types, and knowing the difference is important for cancer treatment decisions.

• Acute Myeloid Leukemia (AML) grows quickly and affects myeloid cells, which normally become red blood cells, some white blood cells, and platelets.

• Chronic Myeloid Leukemia (CML) also involves myeloid cells, but it grows much more slowly, especially in its early stages. CML often doesn't cause symptoms for months or even years and is usually found during a routine blood test.

• Acute Lymphoblastic Leukemia (ALL) is a fast-growing leukemia, but it affects the lymphoid cells, which normally turn into different types of white blood cells. ALL is more common in children, though adults can get it too.

Each of these leukemias affects blood or bone marrow differently. AML typically causes symptoms quickly and often needs induction therapy followed by consolidation therapy or a stem cell transplant, while CML may be managed for years with targeted therapy drugs.

Common Types of AML – M0 to M7

AML isn’t just one disease. Doctors classify it into subtypes (M0 through M7) based on how the cancer cells look under a microscope and how mature they are. These subtypes also help guide acute myeloid leukemia treatment plans.

• M0: Minimally Differentiated AML

These cells are very immature and hard to identify. People with M0 AML might not respond well to standard chemotherapy.

• M1: AML Without Maturation

The cells are slightly more developed than in M0, but still mostly immature. Patients may have symptoms like frequent fevers or infections due to low white blood cells.

• M3: Acute Promyelocytic Leukemia (APL)

This is a unique and more treatable subtype. Patients often have bleeding problems. Treatment often includes specific targeted therapy drugs like all-trans retinoic acid (ATRA) instead of standard chemotherapy.

• M4: Acute Myelomonocytic Leukemia

This type involves both myeloid and monocytic cells. It may cause symptoms like swollen gums or skin rashes due to infiltration by leukemia cells.

• M5: Acute Monocytic Leukemia

More common in younger adults. Like M4, it may present with skin nodules or gum disease. The cells here resemble monocytes more than other types.

• M6: Acute Erythroid Leukemia

M6: Acute Erythroid Leukemia

-M7: Acute Megakaryoblastic Leukemia

This subtype affects the cells that form platelets. It’s more common in children and may occur in people with Down syndrome.

Causes and Risk Factors of Acute Myeloid Leukemia (AML)

Acute myeloid leukemia (AML), or acute myelogenous leukemia, starts in the bone marrow, the spongy tissue inside bones where blood cells are formed. In people with AML, the bone marrow makes abnormal, immature white blood cells (also called myeloblasts) that grow too fast and do not become healthy blood cells. 

These abnormal cells take over the blood and bone marrow space, making it hard for the body to produce enough red blood cells, platelets, and normal white blood cells.

But what causes this to happen? While researchers don’t always know why AML develops in some people and not in others, several known risk factors can increase the chances.

Genetic Mutations and Chromosomal Changes

Many cases of AML begin with changes in the DNA of bone marrow cells. These genetic mutations can cause cells to grow uncontrollably or prevent them from maturing into normal blood cells. In some cases, parts of chromosomes can break off and switch places, known as translocations. These changes can interfere with the genes that control myeloid cells, the type of blood cell AML affects.

These mutations often happen during a person’s life rather than being inherited. For example, someone may live a healthy adult life with no health concerns, then develop a mutation later in life that leads to acute myeloid leukemia AML. This is why many patients wonder, "Why now? I’ve never had health problems before." But the truth is, mutations can silently build up in blood stem cells over time.

Environmental Exposure (Radiation and Chemicals Like Benzene)

Exposure to certain substances in the environment can also lead to AML. One of the most studied chemicals is benzene, which is used in some industries like oil, rubber, and manufacturing. Long-term exposure to benzene has been linked to changes in bone marrow that can lead to leukemia.

People who have been exposed to high levels of radiation—such as survivors of atomic bomb blasts or radiation accidents—also have a higher chance of developing AML. Even some forms of radiation therapy used to treat other cancers may increase this risk.

Imagine someone who worked in a chemical plant for years without realizing they were inhaling benzene fumes. Years later, they start experiencing unusual fatigue and frequent infections. A blood test reveals abnormal blood cells, and they are diagnosed with AML. These real-life exposures show how workplace safety matters deeply when it comes to leukemia.

Smoking and Previous Chemotherapy

Cigarette smoke contains several chemicals known to damage DNA, including benzene. Smoking doesn’t just affect the lungs—it can also harm the blood and bone marrow, raising the chance of developing AML. This surprises many people who associate smoking mainly with lung cancer.

Another lesser-known cause is previous cancer treatment. Some people who had chemotherapy for another cancer may later develop AML. This is sometimes called therapy-related AML. Certain chemotherapy drugs are more likely to cause this, especially when combined with radiation therapy.

Patients might ask, "Why would treatment that saved my life now lead to another cancer?" It’s a painful question with no easy answer. While these treatments can cure some cancers, they can also damage bone marrow over time.

Inherited Syndromes

While most AML cases are not inherited, some people are born with genetic conditions that raise their risk. One example is Down syndrome. Children with Down syndrome have a higher chance of developing a specific type of AML, often before age 5.

Other inherited disorders, such as Fanconi anemia, Li-Fraumeni syndrome, or Bloom syndrome, also increase leukemia risk. These syndromes affect how the body repairs damaged DNA, making it easier for leukemia cells to form.

So, if a child with Down syndrome suddenly becomes pale, bruises easily, or gets repeated infections, a doctor might check for acute myeloid leukemia, even though it's rare in most young children.

Who Is Most at Risk?

AML can affect people of any age, but it is more common in older adults. Most diagnoses happen in people over age 60. That’s because DNA damage in blood stem cells tends to build up over time.

Here are the groups with higher risk:

• Older adults, especially those over age 65

• People with past exposure to benzene or radiation

• People who had chemotherapy or radiation therapy for another cancer

• Smokers

• People with certain inherited syndromes (e.g., Down syndrome)

• Individuals with blood disorders like myelodysplastic syndrome (MDS)

• Those with a family history of leukemia (though rare)

It’s worth asking: if someone has two or three of these risk factors, should they be screened regularly? Unfortunately, there are no standard screening tests for AML, even in high-risk individuals. Many cases are found only when symptoms appear—often suddenly.

What Is Acute Myeloid Leukemia (AML)?

Acute myeloid leukemia (AML) is a fast-growing type of cancer that starts in the bone marrow—the soft part inside bones that makes blood cells. In AML, the bone marrow begins to produce abnormal blood cells, mainly immature white blood cells, which do not work like healthy blood cells. These abnormal cells can crowd out normal red blood cells, white blood cells, and platelets. This affects how your body carries oxygen, fights infection, and stops bleeding.

Early symptoms can be easy to miss or blame on other common illnesses, which is why it’s important to look closely at warning signs.

Fatigue, Fever, and Frequent Infections

Fatigue is one of the most common early symptoms of AML. But this isn’t just regular tiredness after a long day. People with AML often describe a deep kind of exhaustion that doesn’t go away with rest or sleep. You might wake up tired, struggle to get through daily tasks, or feel like you’re running out of energy doing things that were once easy.

A person with AML may also have fevers that come and go, even without any clear infection. This happens because the body is trying to fight something, but the immune system is weakened by the presence of immature white blood cells in the blood and bone marrow.

Frequent infections—such as sore throats, mouth sores, or lung infections—can also appear early. The body doesn’t have enough normal white blood cells to defend itself. For example, someone who normally gets one or two colds a year might suddenly get repeated infections over a short period, needing antibiotics more often than usual.

Real Scenario Example: A 40-year-old man working in an office noticed he was always tired, even after 8 hours of sleep. He also got a cough that kept coming back. After a blood test showed low white cell counts, further testing confirmed acute myeloid leukemia.

Easy Bruising, Bleeding, and Pale Skin

AML affects platelets, which help your blood clot. If there aren’t enough platelets, the person may bruise easily—even from small bumps—or bleed more than usual. This could mean:

• Nosebleeds that don’t stop quickly

• Bleeding gums while brushing teeth

• Small red or purple spots under the skin (called petechiae)

• Cuts that take longer to stop bleeding

Some people also notice they look pale. This is due to a low number of red blood cells, which carry oxygen. Without enough oxygen, you may look washed out or feel dizzy and short of breath.

Bone Pain and Swollen Lymph Nodes

As the disease worsens, bone pain can become a noticeable symptom. It’s not the pain that comes from a fall or injury. Instead, it may feel like a deep ache in the arms, legs, hips, or chest. This happens because the bone marrow is full of abnormal myeloid cells.

Swelling in lymph nodes—especially in the neck, underarms, or groin—can also occur. These nodes are part of the immune system. When they swell, they may feel like small lumps and tender to the touch.

This pain and swelling can sometimes be mistaken for the flu or infection, delaying a proper diagnosis.

When to See a Doctor

So, when should someone be concerned?

It’s easy to ignore early symptoms of acute myeloid leukemia—many of them look like the flu, stress, or tiredness. But some warning signs shouldn’t be brushed off:

• You feel unusually tired for weeks with no clear reason.

• You’re getting sick more often and taking longer to recover.

• You bruise or bleed easily, even from minor bumps or small cuts.

• You notice new lumps in your neck or armpits.

• You feel bone pain that isn’t from injury or strain.

• You become pale and short of breath doing everyday things.

If you notice several of these symptoms together—or if one worsens—it’s time to speak with a doctor. A simple blood test can often show if something is wrong with the blood cells, and further testing can check the bone marrow for signs of acute myeloid leukemia.

Why Recognizing Early Symptoms Matters

AML can move quickly. In many cases, acute myelogenous leukemia goes from the first signs to a serious health problem in a matter of weeks. That’s why early recognition matters.

Treatment sooner—whether it’s chemotherapy, stem cell transplant, radiation therapy, or clinical trials—can help stop the spread of abnormal cells and support the growth of new healthy blood cells.

Some people might wait because they think they’re “just run down” or don’t want to make a fuss. However, catching AML early can make a real difference in acute myeloid leukemia treatment. It’s not about being overly cautious—it’s about being informed.

How Acute Myeloid Leukemia is Diagnosed

When doctors suspect acute myeloid leukemia (AML), they don't rely on just one test. Diagnosing AML is a step-by-step process that involves checking the patient's symptoms, studying their blood and bone marrow, and using lab tests to confirm the type of leukemia. Every detail matters, from the first conversation with the doctor to advanced testing of the bone marrow cells. Here's how the diagnosis unfolds:

Medical History and Physical Examination

The diagnosis usually starts with a basic but important step: talking to the patient.

The doctor will ask detailed questions such as:

• Have you been feeling tired or weak more than usual?

• Have you noticed unexplained bruising or bleeding?

• Are you having frequent infections?

• Have you lost weight without trying?

These questions are not random. Acute myeloid leukemia often causes symptoms like these because it affects how healthy blood cells are made. For instance, if a patient mentions gum bleeding or nosebleeds without any injury, that could be due to low platelet levels. If infections happen often, it could mean white blood cells aren’t working properly.

The doctor will also ask about risk factors—such as prior chemotherapy or radiation, genetic disorders, or family history of blood cancers.

Next, they do a physical exam. They may check for:

• Pale skin (from low red blood cells),

• Swollen lymph nodes,

• Enlarged liver or spleen,

• Bleeding under the skin (small red spots called petechiae).

None of these signs confirm AML alone, but they help guide the next steps.

Blood Tests: Complete Blood Count (CBC) and Blood Smear

The next critical step is drawing blood for lab tests. A complete blood count (CBC) shows the number of each type of blood cell—red blood cells, white blood cells, and platelets.

In people with AML, the CBC may show:

• Very low or very high white cell counts

• Low red cell count (anemia)

• Low platelets (thrombocytopenia)

But here's the key part: these tests also often show immature white blood cells (called blasts) in the bloodstream. Normally, these immature cells stay inside the bone marrow until they mature, but in AML, they spill out into the blood early.

The lab may also prepare a blood smear—a thin layer of blood on a slide, examined under a microscope. The pathologist checks:

• The appearance and shape of the cells

• How many blast cells are present

• Whether cells look normal or abnormal

If blast cells are seen in high numbers, this raises strong suspicion for AML.

Bone Marrow Aspiration and Biopsy

A diagnosis of AML cannot be confirmed without testing the bone marrow, which is where blood cells are made. This test is done by inserting a needle into a large bone (usually the hip) to take a sample. Two samples are taken:

• Bone marrow aspiration – a liquid sample of marrow

• Bone marrow biopsy – a solid core of tissue

These samples help doctors see how many leukemia cells are in the marrow. In AML, more than 20% of the marrow cells are typically abnormal blasts. These immature blood cells take over and prevent the marrow from making normal blood cells.

This step also allows for other important tests, like cytogenetic testing, which examines chromosomes inside the cells.

Cytogenetic Testing and Molecular Studies

AML isn't just one disease—it includes many subtypes. To find out the exact type of acute myeloid leukemia, doctors study the genetic makeup of the leukemia cells.

Two main kinds of tests are done:

• Cytogenetic testing looks at the chromosomes in the cells to check for changes like translocations or deletions. For example, a common change in acute promyelocytic leukemia, a subtype of AML, is called t(15;17).

• Molecular testing checks for gene mutations, such as FLT3, NPM1, or IDH1/2. These mutations can affect the type of acute myeloid leukemia treatment the patient receives.

Why are these tests so important? Some types of AML respond better to certain targeted therapy drugs, while others may need more aggressive treatment, like a stem cell transplant. The genetic tests help decide the treatment plan.

Diagnostic Imaging

Not every patient with AML needs imaging scans, but they may be used in some situations.

For example:

• A chest X-ray might be done to check for lung infections if the patient has a fever.

• CT or MRI scans may be used if symptoms relate to the brain and spinal cord, though this is rare.

• If a lump or unusual tissue is found, imaging can help determine if it's a myeloid sarcoma, a solid tumor of leukemia cells.

Why Each Step Matters

Each test builds on the information from the one before it. Think of it like piecing together a puzzle.

Imagine a 45-year-old man who comes to the clinic with fatigue, night sweats, and pale skin. His CBC shows low red blood cells, platelets, and very high white blood cells. A blood smear reveals immature cells. His bone marrow biopsy confirms more than 30% blast cells and cytogenetic testing shows a mutation that means his AML is more aggressive.

This diagnosis changes everything. It means treatment must begin quickly. He may start with induction therapy (the first intense round of chemo), followed by consolidation therapy and possibly a stem cell transplant if he goes into remission.

Treatment Options for Acute Myeloid Leukemia (AML)

When someone is diagnosed with acute myeloid leukemia, the first question that often comes up is: “What happens next?” The answer depends on the patient’s age, general health, type of AML, and how aggressive the disease is. 

Since AML starts in the bone marrow and affects how blood cells are made, most treatments are aimed at wiping out the abnormal blood cells and helping the body make healthy blood cells again. Here's a detailed look at the main acute myeloid leukemia treatment options.

Chemotherapy: Drugs, Cycles, and Side Effects

Chemotherapy is the most common first step in treating acute myeloid leukemia. The goal is to kill the immature white blood cells (also called leukemia cells) that are multiplying quickly and taking over the blood and bone marrow.

Two Main Phases of Chemotherapy

• Induction Therapy

This is the first intensive round. The goal here is to bring the leukemia into remission by killing as many cancer cells as possible.

• Common drugs used include cytarabine and daunorubicin.

• This phase usually requires staying in the hospital for about 3–4 weeks, since patients are at high risk for infections and bleeding due to low white blood cells and platelets.

• Consolidation Therapy

After remission, there's still a chance some leukemia cells remain. Consolidation therapy aims to destroy those remaining cells.

• Cytarabine may be used again in higher doses.

• Often given in multiple cycles, each lasting a few days with weeks in between for recovery.

Side Effects of Chemotherapy

• Fatigue and weakness

• Mouth sores

• Nausea or vomiting

• Hair loss

• Low red blood cells, which may cause dizziness or shortness of breath

• Low white blood cells, increasing infection risk

• Low platelets, leading to easy bruising or bleeding

Targeted Therapy: How It Works and Who Benefits

Not all AML patients respond the same to chemotherapy. Some people have genetic mutations in their leukemia cells that can be treated with targeted therapy drugs.

What Is Targeted Therapy?

These drugs are designed to attack specific mutations or proteins in cancer cells without damaging most healthy cells.

Examples of Targeted Therapies

• Midostaurin: Used for people with FLT3 gene mutation.

• Gilteritinib: For relapsed or refractory AML with FLT3 mutations.

• Enasidenib and Ivosidenib: Used for IDH2 or IDH1 mutations.

Genetic testing of the bone marrow cells is done early to see if someone might benefit from these drugs.

Scenario: A 60-year-old woman with adult acute myeloid leukemia doesn't respond well to standard chemo. Her tests show an FLT3 mutation. Her doctor starts her on midostaurin, which targets that mutation. Her counts improve, and she begins to regain strength over time.

Stem Cell Transplantation: Types, Eligibility, Risks

A stem cell transplant (also known as a bone marrow transplant) can be an option for some patients after remission is achieved. It replaces damaged or destroyed bone marrow with healthy blood stem cells.

Types of Stem Cell Transplant

• Allogeneic Stem Cell Transplantation

• Donor cells come from a sibling or unrelated person with a matching tissue type.

Used more often in AML.

• The best chance of success if the patient is younger and in good health.

Autologous Stem Cell Transplant

• Uses the patient’s stem cells collected during remission.

• Less common in AML.

Eligibility and Risks

• Not everyone qualifies. People over 65 or those with other health issues may not tolerate the procedure well.

• Risks include graft-versus-host disease, infections, organ damage, and fatigue.

• Recovery can take several months.

Clinical Trials: Access, Benefits, Considerations

Clinical trials are research studies that test new drugs or treatment combinations. For people with refractory AML (AML that doesn’t respond to treatment) or relapsed AML, trials may offer new hope.

Access and Eligibility

• Offered at large cancer centers or hospitals connected to research networks.

• Some trials are open to newly diagnosed patients; others are only for those who have tried standard therapies without success.

• Trials often test new targeted therapies, immunotherapies, or combinations of drugs.

Things to Consider

• Ask about side effects, how the trial compares to standard treatment, and what happens if the trial doesn’t work.

• Patients may have to visit the hospital more often for lab tests and monitoring.

Palliative Care and Supportive Therapies

Some people think palliative care means giving up. That’s not true. It’s about improving comfort and quality of life while treating AML—whether or not a cure is the goal.

Supportive Therapies Include

• Transfusions for red blood cells or platelets to reduce fatigue or bleeding

• Antibiotics to fight infections

• Growth factors to help the bone marrow make more white blood cells

• Pain management and mental health support

• Nutrition support

When Is Palliative Care Used?

• Alongside active treatment like chemo or radiation therapy

• When someone can’t tolerate more intensive therapy

• During late stages of AML or therapy related AML

Conclusion

At PHO, we focus on holistic care for children, adolescents, and young adults with blood-related disorders and cancers. From diagnosis to cure, our team of expert doctors, nurses, and specialists understand the unique challenges younger patients face. We provide personalized treatment plans, emotional support, and long-term follow-up to ensure every child and family receives complete, compassionate care.

We offer comprehensive treatment for:

• Acute and chronic leukemias

• Bone marrow failure syndromes

• Anemia and other red cell disorders

• Bleeding and clotting problems

• Bone marrow and stem cell transplant needs

FAQs

1. Can children get acute myeloid leukemia (AML)? Yes, although AML is more common in adults, it can affect children too. Children with certain genetic conditions like Down syndrome may have a higher chance. Early symptoms in kids can include bruising, tiredness, or infections.

2. How is AML different from other types of leukemia? AML grows fast and affects myeloid cells in the bone marrow. Other types, like chronic myeloid leukemia (CML), grow more slowly. AML needs faster and often more aggressive treatment.

3. Is chemotherapy the only treatment for AML? No. While chemotherapy is often the first step, other treatments include targeted therapy, stem cell transplant, and clinical trials. The best plan depends on the patient’s age, health, and type of AML.

4. What are the risks of a stem cell transplant? Stem cell transplants can help cure AML, but they come with risks like infections, graft-versus-host disease, and fatigue. They are mostly done in younger or healthier patients.

5. Is palliative care only for end-of-life situations? Not at all. Palliative care helps manage symptoms, reduce pain, and support emotional well-being during treatment. It can be part of care from the very beginning—not just when treatment stops.