What is acute myeloid leukemia (AML)?
AML is a fast-growing blood cancer. It’s also called acute myelogenous leukemia. In AML, the body makes unhealthy blood-forming cells (stem cells) that don’t develop properly. These cells grow quickly in the bone marrow (soft, spongy tissue inside the bones). They 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.
How does blood or marrow transplant (BMT) work for AML?
BMT, also known as a bone marrow transplant or blood stem cell transplant, can treat patients who have AML, including older patients. It replaces the unhealthy blood-forming cells (stem cells) with healthy ones. For some people, transplant can cure their disease.
The most common type of transplant for AML is an allogeneic transplant. This type of transplant uses healthy blood-forming cells donated by someone else to replace the unhealthy ones. These healthy cells can come from a family member, unrelated donor or umbilical cord blood. First, you get chemotherapy (chemo), with or without radiation, to kill the unhealthy cells. Then, the healthy cells are given to you through an intravenous (IV) catheter. The new cells travel to the inside of your bones and begin to make healthy blood cells.
The entire process, from when you start chemo or radiation, until hospital discharge, can last weeks to months. This is followed by many months of recovery near the transplant center and at home. Your transplant team will watch you closely to prevent and treat any side effects or complications.
When should I see a transplant doctor?
You or your child should see a transplant doctor right away 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
Your first appointment with a transplant doctor
Even if you don’t need transplant right away, it’s important to see a transplant doctor early. Most patients have a better chance of a cure if they’ve a transplant in the early stage of AML.
At your first appointment, the transplant doctor will:
- Review your medical history
- Talk with you about your treatment options
- Discuss the risks and benefits of 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.
Learn about your risk for relapse
Doctors do cytogenetic and molecular testing to see how likely it is that the AML will come back (relapse). This means they look at the chromosomes and genes in the leukemia cells. Chromosomes and genes tell the body how to make everything it needs to work properly. Certain changes in the AML chromosomes and genes predict a lower risk of relapse. Others predict a higher risk. To do this testing, doctors study your blood and bone marrow.
Ask your doctor for a copy of your test results and to explain what the results mean. If your disease has a high risk of relapse and you’re healthy enough for transplant, it’s important to see a transplant doctor right away.
Questions to ask your doctor
Ask questions so you understand your treatment options and can make decisions that are best for you. Questions you may want to ask your doctor include:
- What are my chances of a cure or 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 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, with or without transplant?
Most recent medical review completed March 2017.