The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells increases.

Symptoms of AML can include:

• skin looking pale or "washed out"
• tiredness
• breathlessness
• having a high temperature, and feeling hot or shivery (fever)
• sweating a lot
• losing weight without trying
• frequent infections
• unusual and frequent bleeding, such as bleeding gums or nosebleeds
• easily bruised skin
• flat red or purple spots on the skin
• bone and joint pain
• a feeling of fullness or discomfort in your tummy
• swollen glands in your neck, armpit or groin that may be sore when you touch them

When to seek medical advice

See a GP if you or your child have the symptoms of AML.

Although it's highly unlikely that AML is the cause, these symptoms need to be investigated and treated promptly.

Acute myeloid leukaemia (AML) is caused by a DNA mutation in the stem cells in your bone marrow that produce red blood cells, platelets and infection-fighting white blood cells.

The mutation causes the stem cells to produce many more white blood cells than are needed.

The white blood cells produced are still immature, so they do not have the infection-fighting properties of fully developed white blood cells.

As the number of immature cells increases, the amount of healthy red blood cells and platelets decrease, and it's this fall that causes many of the symptoms of leukaemia.

Increased risk

It's not known what triggers the genetic mutation in AML, although a number of different things can increase your risk of developing the condition.

Radiation exposure

Being exposed to a significant level of radiation can increase your chances of developing AML, although this usually requires exposure at very high levels.

In the UK, most people are unlikely to be exposed to levels of radiation high enough to cause AML. 

But some people who have had radiotherapy as part of a previous cancer treatment may have a bigger chance of getting AML.

Benzene and smoking

Exposure to the chemical benzene is a known risk factor for AML in adults.

Benzene is found in petrol, and it's also used in the rubber industry, although there are strict controls to protect people from prolonged exposure.

Benzene is also found in cigarette smoke, which could explain why people who smoke have an increased risk of developing AML.

Previous cancer treatment

Treatment with radiotherapy and certain chemotherapy medications for an earlier, unrelated cancer can increase your risk of developing AML many years later.

Blood disorders

People with certain blood disorders, such as myelodysplasia, myelofibrosis or polycythaemia vera, have an increased risk of developing AML.

Genetic disorders

People with certain genetic conditions, including Down's syndrome and Fanconi's anaemia, have an increased risk of developing leukaemia.

In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have blood tests.

A high number of abnormal white blood cells, or a very low blood count in the test sample, could indicate leukaemia.

If this is the case, you'll be urgently referred to a a specialist in treating blood conditions (haematologist).

A haematologist may carry out further tests.

Bone marrow biopsy

To confirm a diagnosis of AML, a small sample of your bone marrow will be taken to examine under a microscope. This procedure is known as a bone marrow biopsy. 

The doctor or nurse will numb an area of skin at the back of your hip bone, before using a thin needle to remove a sample of liquid bone marrow.

In some cases, they'll remove bone and bone marrow together.

You will not feel any pain during the procedure, but it can feel uncomfortable when the sample is being taken.

You may also have bruising and discomfort for a few days afterwards.

The procedure takes around 20 to 30 minutes.

The bone marrow sample will be checked for cancerous cells. If cancerous cells are present, the biopsy can also be used to determine the type of leukaemia you have.

Further tests

Other tests can be used to get more information about the progress and extent of your AML. They can also help decide how it should be treated.

Genetic testing

Genetic tests can be carried out on blood and bone marrow samples to find out what type of AML you have. This can help doctors make decisions about the most appropriate treatment.

Scans

If you have AML, an X-ray or an ultrasound scan of the heart (echocardiogram) may be used to check your organs, such as your heart and lungs, are healthy.

These tests help doctors assess your general health before they decide on the most appropriate treatment for you.

Lumbar puncture

In rare situations where it's thought there's a risk that AML has spread to your nervous system, a lumbar puncture may be carried out.

In this procedure, a needle is used to extract a sample of the fluid that surrounds and protects your spine (cerebrospinal fluid) so it can be checked for cancerous cells.

If cancerous cells are found in your nervous system, it may affect your treatment.

Coping with your diagnosis

Being diagnosed with AML can be particularly difficult, as the condition usually comes on suddenly and treatment has to be started quickly.

This can be upsetting and confusing. But finding out what type of leukaemia you have, what treatment you need and how treatment will affect you can help you cope better and feel more in control.

The Cancer Research UK website has more information and advice about coping with AML.

Acute myeloid leukaemia (AML) is an aggressive cancer that grows quickly, so treatment will usually begin a few days after a diagnosis has been confirmed.

As AML is a complex condition, it's usually treated by a group of different specialists working together called a multidisciplinary team (MDT).

Your treatment plan

Treatment for AML is often carried out in 2 stages:

• induction – this first stage of treatment aims to kill as many leukaemia cells in your blood and bone marrow as possible and treat any symptoms you may have
• consolidation – this stage aims to prevent the cancer coming back (relapsing) by killing any remaining leukaemia cells in your body

The induction stage of treatment is not always successful and sometimes needs to be repeated before consolidation can begin.

If you're thought to have a high risk of experiencing complications of AML treatment (for example, if you're over 75 or have another underlying health condition), less intensive chemotherapy treatment may be carried out.

Your doctors will watch you carefully and suggest other treatments if needed.

Induction

The initial treatment you have for AML will largely depend on whether you're fit enough to have intensive chemotherapy, or whether treatment at a lower dosage is recommended.

Intensive chemotherapy

If you can have intensive induction chemotherapy, you'll be given chemotherapy medication at a high dose to kill the cancerous cells in your blood and bone marrow.

You'll usually be given a combination of 2 or more chemotherapy drugs.

Most people have 2 rounds of induction chemotherapy.

The treatment will be carried out in hospital or in a specialist centre, as you'll need very close medical and nursing supervision.

You may be able to go home between treatment rounds.

You'll have regular blood transfusions because your blood will not contain enough healthy blood cells.

You'll also be vulnerable to infection, so it's important that you're in a clean and stable environment where your health can be carefully monitored and any infection you have can be treated quickly.

You may also be prescribed antibiotics to help prevent infections.

For intensive treatment, the chemotherapy medications will be injected into a thin tube that's inserted either into a blood vessel near your heart or into your arm.

Side effects of intensive chemotherapy for AML are common.

They can include: 

• feeling or being sick
• bruising or bleeding easily
• diarrhoea
• loss of appetite
• sore mouth and mouth ulcers (mucositis)
• tiredness
• skin rashes
• hair loss
• infertility – this may be temporary or permanent (see complications of AML for more information)

Most side effects should resolve once treatment has finished. Tell a member of your care team if side effects become particularly troublesome, as there are medicines that can help you cope better with certain side effects.

Find out more about the side effects of chemotherapy

Non-intensive chemotherapy

If your doctors do not think you're fit enough to withstand the effects of intensive chemotherapy, they may recommend non-intensive treatment.

This involves using an alternative type of chemotherapy to the standard intensive therapy.

The medications used during non-intensive chemotherapy may be given through a drip into a vein, by mouth or by injection under the skin, and can often be given on an outpatient basis.

Other drugs

If you have the type of AML known as acute promyelocytic leukaemia, you'll usually be given other drugs as well as having chemotherapy.

The 2 drugs most commonly used are:

• all tans retinoic acid (ATRA) – usually given during and after induction chemotherapy, it changes immature white blood cells into healthy mature cells, and can reduce symptoms quickly
• arsenic trioxide – usually given if the AML has come back, it speeds up the death of leukaemia cells and changes the immature blood cells into healthy mature cells

Side effects of ATRA can include headaches, nausea, bone pain, and dry mouth, skin and eyes.

Consolidation

If there's no AML left after induction chemotherapy, the next stage of treatment is consolidation.

This often involves receiving regular injections of chemotherapy medication that are usually given in hospital.

The consolidation phase of treatment lasts several months.

Other treatments

Radiotherapy

Radiotherapy involves using high doses of controlled radiation to kill cancerous cells.

It's used to:

• prepare the body for a bone marrow or stem cell transplant
• treat advanced cases that have spread to the nervous system or brain, although this is uncommon

Side effects of radiotherapy can include hair loss, nausea and fatigue.

Most of the side effects should pass once your course of radiotherapy has been completed.

Bone marrow and stem cell transplants

If chemotherapy does not work, a possible alternative treatment option is a bone marrow or stem cell transplant.

Before transplantation can take place, the person receiving the transplant will need intensive high-dose chemotherapy, and possibly radiotherapy, to destroy the cells in their bone marrow.

The donated stem cells are given through a tube into a blood vessel (a drip) in a similar way to chemotherapy medication.

You'll need to stay in hospital for a few weeks after the transplant, usually in a room on your own, because you'll have a high chance of getting infections.

Your friends and family should be able to visit you, but they'll need to wear protective clothing.

Transplantations have better outcomes if the donor has the same tissue type as the person receiving the donation.

The best candidate to provide a donation is usually a brother or sister with the same tissue type.

Find out more about bone marrow donation

Clinical trials and newer unlicensed treatments

In the UK, a number of clinical trials are currently underway that aim to find the best way of treating AML.

Clinical trials are studies that use new and experimental techniques to see how well they work in treating, and possibly curing, AML.

As part of your treatment, your care team may suggest taking part in a clinical trial to help researchers learn more about the best way to treat your AML, and AML in general.

Search the UK Clinical Trials Gateway for clinical trials for AML

If you take part in a clinical trial, you may be offered medication that's not licensed for use in the UK and is not normally available.

But there's no guarantee that the techniques being studied in the clinical trial will work better than current treatments.

Your care team can tell you whether there are any clinical trials available in your area, and can explain the benefits and risks involved.

Cancer Research UK has more information on research into AML.

Your care team

A treatment team for AML may include a:

• haematologist (blood cancer specialist)
• haemato-pathologist (specialist in the study of cancerous blood cells)
• paediatrician (specialist in treating children)
• cancer nurse specialist (sometimes called a CNS), who will be the first point of contact between you and the members of your care team
• radiologist (specialist in X-rays and scans)
• pharmacist
• social worker
• psychologist
• counsellor

If you have acute myeloid leukaemia (AML), you may experience complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment.

Weakened immune system

Having a weakened immune system is a common complication of AML.

Even if your blood is restored to normal working order with treatment, many of the medications that are used to treat AML can temporarily weaken your immune system.

This means you're more vulnerable to developing an infection, and any infection you develop could be more serious than usual.

Complications arising from infection are very common in people with AML. But if treated early, nearly all infections respond to appropriate treatment.

You may be advised to:

• take regular doses of antibiotics to prevent bacterial infections
• maintain good personal and dental hygiene
• avoid contact with anyone who's known to have an infection – even if it's a type of infection that you were previously immune to, such as chickenpox or measles
• check with your GP to make sure your vaccinations are up-to-date – you will not be able to have any vaccine that contains "live" viruses or bacteria, such as the shingles vaccine and MMR vaccine (against measles, mumps and rubella)

Report any possible symptoms of an infection to your treatment unit immediately as prompt treatment may be needed to prevent complications.

Symptoms of an infection can include:

• a sore throat
• a very high temperature, and feeling hot or shivery
• flu-like symptoms, such as headaches, aching muscles and tiredness
• breathlessness
• pain when peeing

Bleeding

If you have AML, you might bleed and bruise more easily because of the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive.

People with advanced AML are more vulnerable to excessive bleeding inside their body.

Serious bleeding can occur:

• inside the skull (intracranial haemorrhage) – causing symptoms such as a severe headache, stiff neck, vomiting and confusion
• inside the lungs (pulmonary haemorrhage) – causing symptoms such as coughing up blood, breathing difficulties and a bluish skin tone (cyanosis)
• inside the stomach (gastrointestinal haemorrhage) – causing symptoms such as vomiting blood and passing poos that are very dark or tar-like in colour

All these types of haemorrhage should be regarded as medical emergencies.

Dial 999 immediately and ask for an ambulance if you think a haemorrhage is occurring.

Infertility

Many of the treatments that are used to treat AML can cause infertility. This is often temporary, but in some cases can be permanent.

People particularly at risk of permanent infertility are those who have received high doses of chemotherapy and radiotherapy in preparation for a bone marrow or stem cell transplant.

Your treatment team can talk to you about the risk of infertility in your specific circumstances.

It may be possible to do things to help keep your fertility before you begin your treatment.

For example, men can have their sperm samples stored. Women can have eggs or fertilised embryos stored, which can then be placed back into their womb following treatment.

But as AML is an aggressive condition that develops rapidly, there may not always be time to do this before treatment needs to start.