Acute myeloid leukemia (AML) is a rare disease that primarily affects the elderly. It is a cancer of the blood and bone marrow that can progress rapidly when left untreated.
Acute myeloid leukemia is the most common acute leukemia in adults and affects 5 out of 100,000 people in Europe1. The five-year survival rate of patients with AML over the age of 60 is less than 10%2, underscoring the seriousness of the disease. In 2024 in the United States, over 20,000 new cases of AML were diagnosed and the disease caused more than 11,000 deaths3. AML accounts for 31% of all leukemias diagnosed in adults over the age of 204.
This type of cancer is characterized by the proliferation of immature cells that circulate in the blood. Because they are not sufficiently developed, these cells cannot function normally. Due to their presence in the blood, the term “leukemia” is used; since they arise from myeloid blast, the term “myeloid” is also associated.
Bone marrow is the tissue in which blood cells are produced in the bones.
How does AML develop?
AML occurs when there are changes during the development stage of stem cell DNA in the bone marrow. The affected stem cell transforms into a leukemic cell and multiplies into millions of “leukemic blasts,” known as myeloblasts. Myeloblasts block the production of normal blood cells, both red and white, as well as platelets, the blood cells produced by bone marrow that play an important role in coagulation.
A decrease in blood cells can be detected through biological tests. One of the main effects observed in patients is neutropenia, i.e., a low level of white blood cells. As a result, the immune system – whose usual function is to protect the body from infections – weakens. Anemia, or a reduction in the number of red blood cells in the blood, can also be observed. Oftentimes, this results in asthenia (significant, generalized fatigue), as well as thrombocytopenia (an abnormal decrease in the number of platelets in the blood).
AML risk factors
For most patients with AML, there are no obvious causes of the disease, and the primary cause is rarely identified. Instead, risk factors can be present, such as repeated exposure to benzene (cigarette smoke, petroleum products, or work environments using benzene). Other risk factors include certain genetic diseases such as Fanconi anemia or Down syndrome, chemotherapy or radiotherapy, or the development of certain cancers and blood diseases. Sometimes, these risk factors can alter the DNA of blood cells located in bone marrow.
How AML is treated
The main treatment for AML is based on chemotherapy, which aims to eliminate cancer cells.
In general, there are two treatment phases, an induction phase and a consolidation phase. The induction phase generally lasts one month and eliminates most cancer cells. Consolidation therapy prevents relapse, i.e., the recurrence of cancer cells. Chemotherapy may be combined with targeted therapies in order to prevent cancer cells from developing. In certain cases, a stem cell transplant may be considered. During both treatment phases of AML, supportive care is provided to help the patient deal with the side effects of treatments and those caused by the disease.
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REMEMBER
[1] ESMO Guidelines 2020 – Acute myeloid leukemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up -https://www.annalsofoncology.org/article/S0923-7534(20)36079-8/fulltext – Annals of Oncology, consulté le 20/02/2025
[2] National Library of Medicine (NIH), Survival for older patients with acute myeloid leukemia: a population-based study, https://pmc.ncbi.nlm.nih.gov/articles/PMC3590098/ – consulté le 20/02/2025
[3] National Cancer Institute, Acute Myeloid Leukemia Treatment (PDQ®)–Health Professional Version, https://www.cancer.gov/types/leukemia/hp/adult-aml-treatment-pdq?#section_1.1 –consulté le 20/02/2025
[4] American Cancer Society, Cancer Facts & Figures 2024