Acute Myeloid Leukemia

Overview

We feel blessed that we’re in a good place where we feel that everything’s going to be OK." Myrella Rico, cancer survivor and acute myeloid leukemia caregiver

If you have been recently diagnosed with acute myeloid leukemia (AML), talk to the specialists at City of Hope’s Gehr Family Center for Leukemia Research.

Our team is an integrated group of experts who will answer your questions, ease your concerns and focus on providing you the best possible care from the moment of diagnosis to active treatment to post-therapy follow up and survivorship.

Request a consultation

If you have been diagnosed with acute myeloid leukemia or are looking for a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673 (HOPE). Please visit Making Your First Appointment for more information. 

City of Hope has been named a best hospital for cancer by U.S. News & World Report for over a decade, and a National Cancer Institute comprehensive cancer center, the highest designation that recognizes our commitment to cancer treatment, research and education. As a founding member of the National Comprehensive Cancer Network, our doctors also help develop and improve evidence-based AML treatment guidelines for patients throughout the country.

Highlights of our AML program include:

  • Comprehensive genetic and molecular profiling of each patient's cancer, so we can identify treatments that will produce the best outcomes
  • A multidisciplinary team of specialists – including hematologists, medical and radiation oncologists, supportive care experts and other professionals – who work together to provide coordinated, personalized care for you and your loved ones
  • A world-class bone marrow and stem cell transplant program with better-than-expected survival outcomes for over 10 years
  • Leading-edge clinical trials for AML not available elsewhere, including T cell immunotherapy, mutation-specific AML drugs and novel stem cell transplant regimens
  • Total marrow irradiation that targets radiation therapy to bone marrow, where AML originates, while minimizing exposure to healthy tissues and organs
  • Long-term, follow up program to minimize risk of recurrence and improve quality of life for AML survivors

 

NEWS & BREAKTHROUGHS

What is acute myeloid leukemia?

Acute myeloid leukemia, or AML, is a disorder involving myeloid stem cells. Normally, myeloid stem cells can self-renew and mature into red blood cells (to deliver oxygen and nutrients to the body’s tissues), white blood cells (to fight infections) and platelets (to stop bleeding).

In patients with AML, the myeloid stem cells behave abnormally and do not transform into mature blood cells, or they transform into irregular blood cells that do not function normally. As abnormal cells build up in the bone marrow and bloodstream, the patient may experience anemia, susceptibility to infections and bleeding that does not clot due to the lack of functional red blood cells, white blood cells and/or platelets.

What risk factors are linked to AML?

Factors that can elevate risk of AML include:

  • A personal or family history of leukemia or blood disorders
  • Prior treatment with radiation or chemotherapy
  • Exposure to radiation or certain chemicals, including benzene and formaldehyde
  • Being male
  • Smoking

What are the symptoms of AML?

Common symptoms associated with AML symptoms include:

  • Unexpected loss of weight or appetite
  • Fatigue
  • Anemia
  • Excessive bleeding and bruises, or bleeding that does not stop
  • Petechiae (flat, round and red pinpoint spots under the skin)
  • Shortness of breath
  • Fevers, chills and other flu-like symptoms
  • Night sweats

Although these symptoms can be caused by other conditions, you should check with a doctor – preferably a hematologist – to get a definitive diagnosis.

Sources: National Cancer Institute and American Cancer Society

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Diagnosing acute myeloid leukemia

An accurate diagnosis is crucial to optimal treatment planning and outcomes. This is especially important for acute myeloid leukemia (AML) because this disease has numerous subtypes and factors that can determine specific courses of treatment.

At City of Hope, our team of experts can precisely diagnose AML, classify its subtype, identify its severity and find the best treatments to fight the disease.

How is AML detected?

Once you notice symptoms, or as part of a routine examination, your doctor may use the following tests to look for AML:

  • Physical exam
  • Blood tests
    • Complete blood count: This test checks for the number of red blood cells, white blood cells and platelets in your blood sample.
    • Peripheral blood smear: Also known as a blood film, this test smears a thin layer of blood on a glass slide for examination under a microscope.
  • Bone marrow aspiration and biopsy: A hollow needle is inserted into your hipbone or breastbone to extract a sample of bone marrow, blood and bone tissue. A pathologist then examines the tissue for signs of cancer.

If cancer is found, additional tests are performed to determine the type and stage of disease. These diagnostic tests include:

  • Cytogenetic analysis: A test that looks for genetic or chromosomal changes in blood or a bone marrow sample.
  • Immunophenotyping: This test looks for specific markers on the surface of a cell, and is used to identify the subtype of AML.
  • Reverse transcription-polymerase chain reaction (RT-PCR) test: This test uses chemicals to look at structure or function of genes, and can help identify AML subtypes.

What are the current screening guidelines for AML?

There are currently no screening guidelines for AML, since no screenings have been shown to lower risk of dying from AML for people of average risk. However, your physician may recommend more vigorous monitoring if you are at a high risk of developing this disease, due to:

  • Personal/family history
  • Specific inherited conditions
  • Prior chemical or radiation exposure
  • Chemotherapy and radiation therapy to treat another cancer

Acute myeloid leukemia treatment options

Each leukemia patient has molecular combinations that are specific to his or her disease … we hope to move away from the ‘one-therapy-fits-all’ approach and implement personalized medicine." Guido Marcucci, M.D., Co-director, Gehr Family Center for Leukemia Research

Your cancer is every bit as unique as you are, and that is why treatment at City of Hope is focused around you and your loved ones.

This means our physicians will personally consult with you about your disease, treatment options and desired outcomes. We will also analyze your specific cancer for genetic and molecular markers that can guide us to more effective therapies. Afterward, our multidisciplinary team will work together to discuss, design and deliver an individual treatment plan to best meet those goals.

The innovative treatments we use to treat acute myeloid leukemia (AML) include drug therapy, radiation therapy and bone marrow/stem cell transplantation.

Drug Therapy

Drug therapy may be given to patients to fight AML cells throughout the body by killing them or stopping their growth and spread. These drugs include:

  • Chemotherapy, which targets rapidly-dividing cells, including AML cells
  • Targeted therapy, which selectively identifies and attacks AML based on specific markers expressed by the cancerous cells
  • Immunotherapy, which stimulates the patient’s own immune system to attack AML cells

For AML, drug treatment is usually divided into several phases:

  • Induction phase to kill leukemia cells throughout the bloodstream and bone marrow
  • Consolidation phase to kill any remaining leukemia cells after induction therapy
  • For certain AML subtypes, a maintenance phase of low-dose cancer-fighting drugs may be given for several months or years afterward to minimize risk of disease relapse.

Drugs may also be prescribed to treat conditions related to AML or its treatments, such as low blood cell counts, nausea or pain.

The drug or drug combination used depends on the AML subtype, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach also evaluates AML cells’ molecular and genetic makeup, which can help identify treatments that are more effective and with fewer side effects.

City of Hope has a wide portfolio of cancer-fighting drugs available in its on-site pharmacy, allowing our medical oncologists to plan and prescribe a drug regimen that can best fight AML while minimizing side effects.

In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.

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Radiation Therapy

Radiation therapy uses focused, high-energy X-rays or other forms of radiation to kill cancer cells.

For AML, radiation is typically used in the following manner:

  • To treat AML cells that have accumulated in specific areas of the body, such as the brain or the spleen
  • Before a stem cell transplant to help kill AML cells throughout the bone marrow and body
  • To treat symptoms caused by AML, such as bone pain

City of Hope is a leader in the use of radiation to treat cancers. Our advanced technologies and experienced staff can plan and deliver radiation precisely to the bone marrow, where AML originates, while sparing nearby organs and tissues. This results in fewer radiation-associated side effects while maintaining excellent clinical outcomes.

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Bone Marrow / Stem Cell Transplantation

Stem cell transplantation allows doctors to deliver greater doses of radiation and drugs to fight AML. After the high-intensity treatments, patients are infused with blood stem cells that will grow and mature in the bone marrow, restoring their blood-forming functions.

The stem cells may be from another donor (allogeneic transplant) or the patient’s own cells (autologous transplant).

City of Hope is one of the world’s largest and most successful bone marrow and stem cell transplant centers. Our Hematologic Malignancies and Stem Cell Transplantation Institute is a leader in setting standards for this lifesaving procedure, improving outcomes for AML patients of all ages.

Highlights of our transplant program include:

  • Recognition as an “overperforming” transplant center for 11 consecutive years by The Center for International Blood and Marrow Transplant Research Center
  • One of the first and most experienced centers to use nonmyeloablative (mini) transplants, which allows a greater range of patients (particularly those too weak to tolerate a standard transplant) to be treated with this lifesaving therapy
  • Integration of transplant and nontransplant therapies, so there is a smoother transition of treatments for AML patients who will eventually need a stem cell transplant
  • Experience in treating a wide range of AML cases, including advance disease and higher risk patients
  • A long-term, follow-up program that monitors for late effects and provide timely interventions

 

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City of Hope’s renowned physicians and researchers in the Hematologic Malignancies and Stem Cell Transplantation Institute utilize the latest in technology and innovation to treat acute myeloid leukemia, coupled with our enduring belief in providing unparalleled compassionate care. Request an appointment online or contact us at 800-826-HOPE.

Anatomic and Clinical Pathology

Karl K. Gaal, M.D.

Clinical Specialties

  • Anatomic and Clinical Pathology
  • Hematopathology

Hematology/Oncology

Joseph Alvarnas, M.D.

Clinical Specialties

  • Hematology/Oncology
Stephen J. Forman, M.D., F.A.C.P.

Clinical Specialties

  • Hematology/Oncology
Samer K. Khaled, M.D.

Clinical Specialties

  • Hematology/Oncology
Guido Marcucci, M.D.

Clinical Specialties

  • Hematology/Oncology
Matthew Genyeh Mei, M.D.

Clinical Specialties

  • Hematology/Oncology
Ryotaro Nakamura, M.D.

Clinical Specialties

  • Hematology/Oncology
Margaret R. O'Donnell, M.D., F.R.C.P.C.

Clinical Specialties

  • Hematology/Oncology
Pablo M Parker, M.D.

Clinical Specialties

  • Hematology/Oncology
Vinod A Pullarkat, M.D.

Clinical Specialties

  • Hematology/Oncology
Eileen P. Smith, M.D.

Clinical Specialties

  • Hematology/Oncology
David S. Snyder, M.D., F.A.C.P.

Clinical Specialties

  • Hematology/Oncology
Anthony S. Stein, M.D.

Clinical Specialties

  • Hematology/Oncology

Pediatric Hematology-Oncology

Anna Pawlowska, M.D.

Clinical Specialties

  • Pediatric Hematology-Oncology
Joseph Rosenthal, M.D., M.H.C.M.

Clinical Specialties

  • Pediatric Hematology-Oncology

Radiation Oncology

Jeffrey Y.C. Wong, M.D.

Clinical Specialties

  • Radiation Oncology

Acute myeloid leukemia research and clinical trials

At City of Hope, acute myeloid leukemia (AML) clinicians and researchers collaborate extensively to develop and evaluate new therapies for better survival and quality-of-life outcomes. Our patients have access to a wide variety of clinical trials including new chemotherapy and targeted therapies, hormone therapies with fewer side effects, novel surgical techniques, innovative radiation approaches and new prevention strategies.

These trials give current patients access to promising, leading-edge therapies and improve overall care for future patients worldwide.

Visit our clinical trials page to learn more about current studies and their eligibility criteria.

Some of our current research projects include:

  • CAR-T cell therapy: Immune system cells called T cells guard against disease; they can detect invaders such as bacteria and viruses and destroy them. City of Hope scientists are currently investigating to see how these cells can be reprogrammed to recognize and attack leukemia, as well.
  • Improving AML subtype profiling: AML is actually a collection of over 100 abnormalities that lead to uncontrolled cell growth. Our researchers are actively studying these AML subtypes, and whether they have specific genetic or molecular targets to focus therapy on.
  • Investigating "leukemia stem cells" that allow the disease to relapse and grow following cancer treatment. By better understanding the biology of these cancer stem cells, scientists and clinicians hope to develop more effective therapies that produce lasting cures.
  • Enhance bone marrow/stem cell transplants: While stem cell transplants can be a lifesaving procedure for patients with AML, they also carry a risk of graft-versus-host disease (GvHD), in which the newly transplanted stem cells do not recognize the recipient’s body as their own and start producing an immune response against it, leading to chronic and potentially serious complications. To reduce the likelihood of GvHD and to improve transplant outcomes, City of Hope is researching new ways to classify and match stem cell donors and recipients.

 

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Living with acute myeloid leukemia

When you feel like giving up, that’s when you need to push harder … never give up because it’s really worth it."  Nicole Schulz, acute myeloid leukemia survivor

When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your loved ones take each step during and after your acute myeloid leukemia treatment.

We can help with all of the following concerns, and more:

  • Managing symptoms and side effects, such as pain, nausea and fatigue
  • Recovering after stem cell transplantation
  • Handling emotional, social and spiritual issues in group or one-on-one settings
  • Coping with the stress of diagnosis, treatment and recovery
  • Addressing fertility and family planning issues
  • Navigating the health care system, including related legal and financial issues
  • Maintaining a healthy lifestyle with expert nutrition and physical activity guidance
  • Building caregiver skills
  • Improving communication with family, partners and loved ones
  • Restoring normalcy in your family, job or school routine
  • Restoring your body and mind through healing arts workshops
  • Connecting with and learning from other patients and survivors
  • Returning to wellness after active treatment

Learn more about these resources at our Living with Cancer or Supportive Care Medicine sites.

For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE).

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Nicole Schulz Success Story Image
Nicole, leukemia survivor

After two bone marrow transplants and tremendous perseverance, Nicole is back to living the life she once knew – and making up for lost time.

Ian, leukemia survivor

At a certain point during his treatment for leukemia at City of Hope, Ian MacLeod stopped asking “Why” he had cancer, and started asking “What?”.

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