The bone marrow and blood cells
All of the blood cells in your body are produced in the bone marrow: the spongy tissue that is found in the middle of your bones. All blood cells start their lives as stem cells. These grow and divide within the bone marrow and mature into:
- Red blood cells that carry oxygen around the body
- White blood cells that help fight infection
- Platelets that help clot the blood to control bleeding and bruising.
When leukaemia occurs, the bone marrow produces a large amount of immature blood cells, which do not develop any further. These do not work properly as they have not matured into the type of cell they were supposed to be.
Leukaemia usually affects the production of white blood cells. Acute myeloid leukaemia (AML) is named after the early white myeloid blood cells it affects. There are a number of different types of AML, which are diagnosed by looking at how the leukemia cells look compared to a normal mature myeloid cell. Each type needs a slightly different treatment plan, so it’s best to talk to your specialist for more information.
The other main type of leukaemia seen in young people is acute lymphoblastic leukaemia (ALL). This is named after the early lymphoid white blood cells (which are called ‘lymphoblasts’) that it affects. See our acute lymphoblastic leukaemia page for more information about the diagnosis and treatment of this cancer.
Acute myeloid leukaemia can occur in anyone of any age.
When leukaemia occurs, the over production of immature white blood cells squeezes out the production of healthy blood cells. This can lead to:
- Anaemia: the number of red blood cells are reduced, leaving you feeling tired, breathless and constantly run down
- Bruising and bleeding: the number of platelets are reduced, which means your blood is not able to clot as well as it did previously
- Infections: you may get infections more often as there are less healthy blood cells to fight them.
Acute myeloid leukaemia is usually suspected from a blood test, which will reveal changes in the numbers of healthy white blood cells. If the blood test suggests that leukaemia is present, a specialist will need to take a sample of your bone marrow. This sample will be looked at under a microscope to work out what type of leukaemia you have.
Your specialist will also need to do a lumbar puncture to see if your spinal fluid contains any leukaemia cells.
Acute myeloid leukaemia is usually treated in two phases.
The first phase, known as ‘induction’, aims to destroy your leukaemia cells with chemotherapy and get you into remission. When you are in remission, there are no leukaemia cells visible through a microscope in your blood or bone marrow. This phase usually takes four to six weeks and you may need to spend most of this time at the hospital to reduce your risk of infections.
You will then have ‘consolidation treatment’ to stop your leukaemia coming back. This may mean more chemotherapy or a transplant of bone marrow or stem cells from a donor.
If leukaemia cells remain after your treatment, or come back, you may need further chemotherapy or a stem cell transplant.
Your particular treatment plan will depend on your leukaemia and how it responds to treatment, so it’s best to talk to your specialist about what will be involved.
If you are undergoing chemotherapy, you may experience side-effects such as tiredness, sickness, diarrhoea and temporary hair loss. You will also be at greater risk of infections. For more information about how side-effects can be managed, talk to your specialist or nurses, or see the side-effects section of our website.
After your treatment is complete you will still need to be seen regularly at an outpatient clinic. At this clinic, your specialist will be looking for any signs that your cancer has returned (this is known as a relapse). They will also check that your major organs, such as your heart and lungs, are still functioning correctly and haven’t been affected by your cancer treatment.
Long-term follow up
Once your risk of relapse has reduced, the focus of on-going follow up changes to looking out for potential long term side effects of treatment. The risk of long term side effects depends on the type of cancer you had and the treatment you received. A personalised surveillance plan is usually created that outlines the specific long term follow up and on-going investigations that you require. Most people are at low risk of future health problems but some will have significant on-going health needs.
Undergoing treatment for AML can lead to a range of long-term effects (though these vary from person to person and you may not experience any at all). These can include fatigue, a lower resistance to infections, infertility, and heart or thyroid problems. Talk to your specialist about the potential long-term side-effects of your treatment.
Updated December 2014, next review planned 2017.