Acute myeloid leukemia
| Acute myeloid leukemia | |
|---|---|
| Other names | Acute myelogenous leukemia, acute nonlymphocytic leukemia (ANLL), acute myeloblastic leukemia, acute granulocytic leukemia[1] |
| Acute myeloid leukemia. In the cytoplasm of individual cells, you can see characteristic inclusions – Auer rods | |
| Specialty | Hematology, oncology |
| Symptoms | Feeling tired, shortness of breath, easy bruising and bleeding, increased risk of infection[1] |
| Usual onset | 65–70 years old |
| Risk factors | Smoking, previous chemotherapy or radiation therapy, myelodysplastic syndrome, benzene[1] |
| Diagnostic method | Bone marrow aspiration, blood test[2] |
| Treatment | Chemotherapy, radiation therapy, stem cell transplant[1][2] |
| Prognosis | Five-year survival ~29% (US, 2017)[3] |
| Frequency | 145,000 per year (2021) |
| Deaths | 130,000 (2021) |
Acute myeloid leukemia (AML) is a cancer of the myeloid line of blood cells, characterized by the rapid growth of abnormal cells that build up in the bone marrow and blood and interfere with normal blood cell production.[1] Symptoms may include feeling tired, shortness of breath, easy bruising and bleeding, and increased risk of infection.[1] Occasionally, spread may occur to the brain, skin, or gums.[1] As an acute leukemia, AML progresses rapidly, and is typically fatal within weeks or months if left untreated.[1]
Risk factors include getting older, being male,[4] smoking, previous chemotherapy or radiation therapy, myelodysplastic syndrome, and exposure to the chemical benzene.[1] The underlying mechanism involves replacement of normal bone marrow with leukemia cells, which results in a drop in red blood cells, platelets, and normal white blood cells.[1] Diagnosis is generally based on bone marrow aspiration and specific blood tests.[2] AML has several subtypes for which treatments and outcomes may vary.[1]
The first-line treatment of AML is usually chemotherapy, with the aim of inducing remission.[1] People may then go on to receive additional chemotherapy, radiation therapy, or a stem cell transplant.[1][2] The specific genetic mutations present within the cancer cells may guide therapy, as well as determine how long that person is likely to survive.[2]
Between 2017 and 2025, 12 new agents have been approved for AML in the U.S., including venetoclax (BCL2 inhibitor), gemtuzumab ozogamicin (CD33 antibody-drug conjugate), and several inhibitors targeting FMS-like tyrosine kinase 3, isocitrate dehydrogenase, and other pathways. Additionally, therapies like CPX351 and oral formulations of azacitidine and decitabine-cedazuridine have been introduced. Ongoing research is exploring menin inhibitors and other antibody-drug conjugates.[5]
Low-intensity treatment with azacitidine plus venetoclax has emerged as the most effective option for older or unfit AML patients, based on a network meta-analysis of 26 trials involving 4,920 participants. It showed the highest survival and remission rates, with low-dose cytarabine (LDAC) plus glasdegib and LDAC plus venetoclax also showing clinical benefit.[6]
In 2015, AML affected about one million people, and resulted in 147,000 deaths globally.[7][8] It most commonly occurs in older adults.[3] Males are affected more often than females.[3] The five-year survival rate is about 35% in people under 60 years old and 10% in people over 60 years old.[2] Older people whose health is too poor for intensive chemotherapy have a typical survival of five to ten months.[2] It accounts for roughly 1.1% of all cancer cases, and 1.9% of cancer deaths in the United States.[3]
- ^ a b c d e f g h i j k l m "Adult Acute Myeloid Leukemia Treatment". National Cancer Institute. 6 March 2017. Retrieved 19 December 2017.
- ^ a b c d e f g Döhner H, Weisdorf DJ, Bloomfield CD (September 2015). "Acute Myeloid Leukemia". The New England Journal of Medicine. 373 (12): 1136–1152. doi:10.1056/NEJMra1406184. PMID 26376137. S2CID 40314260.
- ^ a b c d "Acute Myeloid Leukemia – Cancer Stat Facts". NCI. Retrieved 10 May 2017.
- ^ "Risk Factors for Acute Myeloid Leukemia (AML)". cancer.org. Retrieved 5 June 2024.
- ^ Kantarjian HM, DiNardo CD, Kadia TM, Daver NG, Altman JK, Stein EM, Jabbour E, Schiffer CA, Lang A, Ravandi F (2025). "Acute myeloid leukemia management and research in 2025". CA: A Cancer Journal for Clinicians. 75 (1): 46–67. doi:10.3322/caac.21873. ISSN 1542-4863. PMC 11745214. PMID 39656142.
- ^ Li W, Kang S, Jiao Y, Yue P, Dong W, Ge R, Wang Z, Yan X (15 April 2025). "Comparative efficacy and safety in low-intensity treatment for acute myeloid leukemia in older patients: a systematic review and network meta-analysis". European Journal of Medical Research. 30 (1): 280. doi:10.1186/s40001-025-02476-9. ISSN 2047-783X. PMC 11998139. PMID 40229815.
- ^ Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators) (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
- ^ Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (GBD 2015 Mortality and Causes of Death Collaborators) (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.