General signs and symptoms of the early stages of acute myelogenous leukemia may mimic those of the flu or other common diseases. Signs and symptoms may vary based on the type of blood cell affected. Signs and symptoms of acute myelogenous leukemia include:

• Fever
• Weight loss
• Bone pain
• Lethargy and fatigue
• Shortness of breath
• Pale skin
• Frequent infections
• Easy bruising
• Unusual bleeding, such as frequent nosebleeds and bleeding from the gums

When to see a doctor
Make an appointment with a doctor if you develop any signs or symptoms that seem unusual or that worry you. Acute myelogenous leukemia worsens quickly if not treated, so a prompt diagnosis is helpful.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Acute myelogenous leukemia is caused by damage to the DNA of developing cells in your bone marrow. When this happens, blood cell production goes awry. The bone marrow produces immature cells that develop into leukemic white blood cells called myeloblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells.

It's not clear what causes the DNA mutations that lead to leukemia. Radiation, exposure to certain chemicals and some chemotherapy drugs may play a role. It's believed that most cases of acute myelogenous leukemia aren't inherited.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Factors that may increase your risk of acute myelogenous leukemia include:

• Increasing age. Acute myelogenous leukemia is most common in adults age 60 and older.
• Your sex. Men are more likely to develop acute myelogenous leukemia than are women.
• Previous cancer treatment. People who've had certain types of chemotherapy and radiation therapy or treatment for childhood acute lymphocytic leukemia (ALL) may have a greater risk of developing AML.
• Exposure to radiation. People exposed to very high levels of radiation, such as survivors of an atomic bomb blast or a nuclear reactor accident, have an increased risk of developing AML.
• Dangerous chemical exposure. Exposure to certain chemicals, such as benzene — which is found in unleaded gasoline and used by the chemical industry — also is linked to greater risk of AML.
• Smoking. AML is linked to cigarette smoke, which contains benzene and other known cancer-causing chemicals.
• Other blood disorders. People who've had another blood disorder, such as myelodysplasia, polycythemia vera or thrombocythemia, are at greater risk of developing AML.
• Genetic disorders. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of AML.

Many people with AML have no known risk factors, and many people who have risk factors never develop the cancer.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a doctor who specializes in blood cell diseases (hematologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For acute myelogenous leukemia, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Should I seek a second opinion? What will that cost, and will my insurance cover a second opinion?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime
Avoid activities that worsen your signs and symptoms. For instance, try to take it easy if you find that you're feeling fatigued.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

If you have signs or symptoms of acute myelogenous leukemia, your doctor may recommend you undergo diagnostic tests, including:

• Blood tests. Most people with acute myelogenous leukemia have too many white blood cells, not enough red blood cells and not enough platelets. The presence of blast cells — immature cells that are usually found in the bone marrow, but not normally circulating in the blood — is another indicator of acute myelogenous leukemia.
• Bone marrow test. A blood test can suggest leukemia, but it usually takes a bone marrow test to confirm the diagnosis. During a bone marrow biopsy, a needle is used to remove a sample of your bone marrow. Usually, the sample is taken from your hipbone (posterior iliac crest). The sample is sent to a laboratory for testing.
• Spinal tap (lumbar puncture). In some cases, it may be necessary to remove some of the fluid around your spinal cord to check for leukemia cells. Your doctor can collect this fluid by inserting a small needle into the spinal canal in your lower back.

If your doctor suspects leukemia, you may be referred to a doctor who specializes in cancer (oncologist) or a doctor who specializes in blood and blood-forming tissues (hematologist).

Determining your AML subtype
If your doctor determines you have AML, you may need further tests to determine the extent of the cancer and classify it into one of the eight subtypes of AML. In AML, the subtypes are based on:

• How mature the cancer cells are at the time of diagnosis
• How different the cancer cells are from normal cells
• The number and location of specific changes within the cancer cells' DNA

Your AML subtype helps determine which treatments may be best for you. Doctors are studying how different types of cancer treatment affect people with different AML subtypes.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Treatment of acute myelogenous leukemia depends on several factors, including the subtype of the disease, your age, your overall health and your preferences. In general, treatment falls into two phases:

• Remission induction therapy. The purpose of the first phase of treatment is to kill the leukemia cells in your blood and bone marrow. However, remission induction usually doesn't wipe out all of the leukemia cells, so you need further treatment to prevent the disease from returning.
• Consolidation therapy. Also called post-remission therapy, maintenance therapy or intensification, this phase of treatment is aimed at destroying the remaining leukemia cells. It's considered crucial to decreasing the risk of relapse.

Therapies used in these phases include:

• Chemotherapy. Chemotherapy is the major form of remission induction therapy, though it can also be used for consolidation therapy. Chemotherapy uses chemicals to kill cancer cells in your body. People with AML generally stay in the hospital during chemotherapy treatments because the drugs destroy many normal blood cells in the process of killing leukemia cells. If the first cycle of chemotherapy doesn't cause remission, you may need it repeated one or two more times.
• Other drug therapy. Arsenic trioxide (Trisenox) and all-trans retinoic acid (ATRA) are anti-cancer drugs that can be used alone or in combination with chemotherapy for remission induction of a certain subtype of AML called promyelocytic leukemia. These drugs cause leukemia cells with a specific gene mutation to mature and die, or to stop dividing.
• Biological therapy. Also known as immunotherapy, biological therapy uses substances that bolster your immune system's response to cancer. Monoclonal antibodies are one form of biological therapy. These antibodies are produced in a laboratory, but they mimic proteins in your immune system (antibodies) that attack foreign substances on leukemic cells. One monoclonal antibody used as a biological therapy in AML is gemtuzumab ozogamicin (Mylotarg). This drug carries a chemical toxin that releases when it attaches to AML cells.
• Bone marrow stem cell transplant. Bone marrow stem cell transplant may be used for consolidation therapy. Bone marrow stem cell transplant helps re-establish healthy stem cells by replacing unhealthy bone marrow with leukemia-free stem cells that will regenerate healthy bone marrow. Prior to a stem cell transplant, you receive very high doses of chemotherapy or radiation therapy to destroy your leukemia-producing bone marrow. Then you receive infusions of stem cells from a compatible donor (allogeneic transplant). You can also receive your own stem cells (autologous transplant) if you were previously in remission and had your healthy stem cells removed and stored for a future transplant.
• Clinical trials. Some people with leukemia choose to enroll in clinical trials to try experimental treatments or new combinations of known therapies.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

No alternative treatments have been found helpful in treating acute myelogenous leukemia. But some complementary and alternative treatments may relieve the signs and symptoms you experience due to cancer or cancer treatment.

Alternative treatments that may help relieve signs and symptoms include:

• Acupuncture
• Aromatherapy
• Massage
• Meditation
• Relaxation exercises

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Over the past several decades, doctors have made good progress in treating people with acute myelogenous leukemia, and research continues. But that doesn't necessarily make the diagnosis any less scary.

Acute myelogenous leukemia is an aggressive form of cancer that typically demands quick decision making. That leaves people with a brand-new diagnosis scrambling to make hasty choices about a disease that they can barely pronounce — let alone understand. Here are some tips for coping:

• Get down to particulars. The term "leukemia" can be confusing because it refers to a batch of cancers that aren't all that similar except for the fact that they affect the bone marrow and blood. You can waste a lot of time researching information that doesn't apply to your kind of leukemia. To avoid that, ask your doctor to write down as much information about your specific disease as possible. Then narrow your search for information accordingly.

  Write down questions you want to ask your doctor before each appointment, and look for information in your local library and on the Internet. Good sources include the National Cancer Institute, the American Cancer Society and The Leukemia & Lymphoma Society.

• Lean on family and friends. It can be tough to talk about your diagnosis, and you'll likely get a range of reactions when you share the news. But talking about your diagnosis can be helpful. So can the outpouring of practical help that often results.
• Take care of yourself. It's easy to get caught up in the tests, treatments and procedures of therapy. But it's important to take care of yourself, not just the cancer. Try to make time for yoga, gardening, cooking or other favorite diversions.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.