Acute myeloid leukemia (AML)

Acute myeloid leukemia (AML) is a fast-growing blood cancer that causes the body to make unhealthy blood-forming cells (blood stem cells) that don’t develop properly. These cells grow quickly in the bone marrow and prevent the marrow from making normal red blood cells, white blood cells and platelets. With fewer healthy blood cells, the body can’t fight infections or stop bleeding. AML primarily affects adults aged 60 and older, but it can also appear in children and young adults.

A blood or marrow transplant (BMT), also known as a bone marrow or blood stem cell transplant, can treat AML, including in older patients. It replaces unhealthy blood stem cells with healthy ones from a donor. For some, it can be a cure for their disease.

For AML, doctors use an allogeneic transplant, meaning the donated cells come from someone else. These healthy blood-forming cells can come from:

• A family member
• An unrelated donor
• Umbilical cord blood

Although each person’s journey is unique, bone marrow transplantation for acute myeloid leukemia typically follows a series of distinct phases. From initial therapy to the infusion of donor cells and ongoing recovery, here’s how the transplant process generally works.

• Preparation: You’ll begin with chemotherapy (and sometimes radiation) to destroy the unhealthy marrow. This step, called conditioning therapy, makes room for new, healthy blood-forming cells.
• Transplant: Next, healthy donor cells are delivered through an intravenous (IV) catheter, often referred to as a stem cell infusion. These cells travel to the inside of your bones and begin producing new blood cells.
• Recovery: Full recovery can take several months to a year. From the start of conditioning to leaving the hospital can take weeks to months. You’ll then spend additional time recovering near the transplant center and at home. During this period, your transplant team carefully monitors you, helping prevent and manage any side effects or complications.

If you or your child are diagnosed with AML, you should see a transplant doctor right away. Younger patients who have a closely matched donor and get a transplant soon after diagnosis may have a better chance for a cure. You should also see a transplant doctor immediately if:

• The AML is in first complete remission (no signs of disease) unless it has a low risk of coming back
• You had a disease such as myelodysplastic syndrome (MDS) that became AML
• The AML was caused by another treatment, such as chemo for another disease
• The initial chemo doesn’t lead to remission (no signs of disease)
• The AML comes back 1 or more times after treatment
• Your child is under the age of 2 years when diagnosed

Even if a transplant isn’t needed right away, it’s still important to schedule an appointment with a transplant doctor. Many AML patients depend on blood transfusions, but repeated transfusions can reduce the likelihood that a future transplant will be successful. For this reason, most doctors recommend meeting with a transplant specialist as soon as AML is diagnosed.

Scheduling an appointment with a doctor to discuss your AML diagnosis is the first step to finding a cure.

At your first appointment, the transplant doctor will:

• Review your medical history.
• Talk with you about AML treatment options.
• Discuss the risks and benefits of BMT transplant.
• Recommend the best time for you to get a transplant and prepare for treatment.
• Start a donor search even if you don’t need a transplant right away. This can help you get a transplant faster if it’s needed later.

Patients that come from ethnically diverse backgrounds will often have a harder time finding a matching bone marrow donor. This is because of genes called human leukocyte antigens (HLAs), which are the codes inside your body doctors use to help find a match. HLAs are inherited, which means it will be easier to find a match using a patient and donor that share the same ancestry.

Unfortunately, not all ethnicities are equally represented on the registry.

Learn more about the importance of diversity

Doctors perform cytogenetic and molecular testing to determine how likely it is that someone’s AML will relapse or come back. To do this, doctors analyze the chromosomes and genes inside the leukemia cells certain changes that help predict a lower or higher risk of relapse. To perform this testing, doctors study your blood and bone marrow.

It’s important to ask your doctor for a copy of your test results and to explain what they mean. If your AML has a high risk of relapse and you’re healthy enough for transplant, it’s important to see a transplant doctor right away.

Ask questions so you can best understand the treatment options available for your acute myeloid leukemia. Questions you may want to ask your doctor include:

• What are my chances of curing or entering long-term remission if I get a transplant? If I don’t get a transplant?
• Does the type of AML I have make a difference on how well transplant might work for me?
• Does my current health or age affect how well a bone marrow or blood stem cell transplant might work for me?
• What do my cytogenetic and molecular markers mean for my treatment?
• What are the possible side effects of transplant? How can they be reduced?
• How might my quality of life change over time due to AML, with or without transplant?

We can help you and your loved ones diagnosed with AML by:

• Answering questions about your AML diagnosis and treatment options
• Connecting you with counselors to help cope with uncertainty
• Helping you access financial grants
• Providing access to free educational resources including fact sheets, booklets and webinars
• Answering questions about the transplant process
• Helping you find and join clinical trials
• Connecting you with others who have been diagnosed with AML

Having as much information as possible on your treatment options for AML will help you and your doctor make the best treatment decisions for your individual case. We’ve outlined some of our key resources below.