Adult acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes abnormal myeloblasts (a type of white blood cell), red blood cells, or platelets. This is a cancer of the blood and bone marrow.

• This type of cancer usually gets worse quickly if it is not treated.
• It is the most common type of acute leukemia in adults.
• AML is also called acute myelogenous leukemia, acute myeloblastic leukemia, acute granulocytic leukemia, and acute nonlymphocytic leukemia.

See CLL for myeloid stem cell types.

• In AML, the myeloid stem cells usually become a type of immature white blood cell called myeloblasts (or myeloid blasts).
• The myeloblasts in AML are abnormal and do not become healthy white blood cells.
• Sometimes in AML, too many stem cells become abnormal red blood cells or platelets.
• These abnormal white blood cells, red blood cells, or platelets are also called leukemia cells or blasts.
• Leukemia cells can build up in the bone marrow and blood so there is less room for healthy white blood cells, red blood cells, and platelets.
• When this happens, infection, anemia, or easy bleeding may occur.
• The leukemia cells can spread outside the blood to other parts of the body, including the central nervous system (brain and spinal cord), skin, and gums.

There are different subtypes of AML. Most AML subtypes are based on how mature (developed) the cancer cells are at the time of diagnosis and how different they are from normal cells.

• Acute promyelocytic leukemia (APL) is a subtype of AML that occurs when parts of two genes stick together.
  • • APL usually occurs in middle-aged adults.
    • Signs of APL may include both bleeding and forming blood clots.

The treatment of adult AML usually has 2 phases.

• Remission induction therapy: This is the first phase of treatment. The goal is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.
• Post-remission therapy: This is the second phase of treatment. It begins after the leukemia is in remission. The goal of post- remission therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse.
  • This phase is also called remission continuation therapy.

Stem Cell Transplant
A procedure in which a patient receives healthy stem cells (blood-forming cells) to replace their own stem cells that have been destroyed by treatment with radiation or high doses of chemotherapy.

• The healthy stem cells may come from the blood or bone marrow of the patient or from a related or unrelated donor.
• A stem cell transplant may be autologous (using a patient’s own stem cells that were collected and saved before treatment), allogeneic (using stem cells from a related or unrelated donor), syngeneic (using stem cells donated by an identical twin), or cord blood (using umbilical cord blood donated after a baby is born).

Chemotherapy with stem cell transplant
Chemotherapy is given to kill cancer cells.

• Healthy cells, including blood-forming cells, are also destroyed by the cancer treatment.
• Stem cell transplant is a treatment to replace the blood-forming cells.
• Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the patient completes chemotherapy and/or total-body irradiation, the stored stem cells are thawed and given back to the patient through an infusion.
• These reinfused stem cells grow into (and restore) the body’s blood cells.

Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells.

Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. There are different types of targeted therapy:

• Monoclonal antibodies:  Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer.
• Gemtuzumab ozogamicin is a type of antibody-drug conjugate used to treat patients with newly diagnosed or relapsed AML. It contains a monoclonal antibody that binds to CD33, which is found on some leukemia cells, and also contains a toxic substance, which may help kill cancer cells.
  Midostaurin, a protein kinase inhibitor used with certain types of chemotherapy to treat newly diagnosed patients with AML that has a mutation in the FLT3 gene.
• Gilteritinib, a tyrosine kinase inhibitor that may be used to treat patients with AML that has come back or did not get better with other treatment and has a mutation in the FLT3 gene.
  Glasdegib, ivosidenib, and enasidenib, which may be used as less intensive treatments in older or frail patients who cannot receive standard treatment.

Other drug therapy

• Arsenic trioxide and all-trans retinoic acid (ATRA) are anticancer drugs that kill leukemia cells, stop the leukemia cells from dividing, or help the leukemia cells mature into white blood cells.
• These drugs are used in the treatment of a subtype of AML called acute promyelocytic leukemia.

Radiation therapy
Chemotherapy