When you first find out you have acute myeloid leukemia (AML), you'll likely have lots of questions and a swirl of different feelings. Take some time now to learn about the kinds of tests you need and your treatment options. And make sure you reach out to family and friends to get the emotional backing you need.
After your diagnosis, you'll see a specialist called a hematologist-oncologist, who treats blood cancers like leukemia. He'll do tests to learn the type of AML you have, which helps him figure out the best treatment.
Tests for AML Subtype
Most cases of AML come from immature blood cells -- ones that haven't fully developed yet -- that will later grow into white blood cells (other than the type called lymphocytes). In some cases, AML starts in other types of blood-forming cells.
Doctors divide AML into subtypes based on:
- The type of blood cell where the cancer started
- How developed the cancer cells look under a microscope
- Whether the cells have certain gene changes
Your doctor will ask you to take some tests to find out which subtype you have. He'll first take a sample of blood from a vein in your arm. He may also get a sample of your bone marrow -- the spongy area inside your bones that makes blood cells.
There are two ways to get a bone marrow sample:
Bone marrow aspiration. It removes a small amount of liquid from inside your bone -- usually near your hip -- with a hollow needle.
Bone marrow biopsy. It takes out a small piece of bone and marrow with a larger needle.
Your samples go to a lab, where technicians do tests like these to find your AML subtype:
Cytochemistry. This test uses special dyes that make only certain types of AML cells change color.
Flow cytometry. It looks for markers on the surface of cancer cells.
Immunohistochemistry. The test uses a special substance that makes some types of AML cells turn colors when seen under a microscope.
Cytogenetics. Technicians look for gene changes, like chromosomes that are missing or have switched places.
Fluorescent in situ hybridization (FISH). This test also checks for changes in genes. Your doctor uses a dye that lets him see chromosome changes when he looks under a microscope. Some of those changes can't be spotted in cytogenetic testing.
Polymerase chain reaction (PCR). If your doctor wants to find gene changes that are so small he can't see them under a microscope, he may suggest you get a PCR test. It can spot changes that may be in only a small number of cells.
Chemotherapy is the main way to treat AML. It uses strong drugs to kill cancer cells. You get these drugs through an IV, by mouth, or get them injected under your skin.
You might also get one of these treatments:
Targeted therapy. This uses drugs that block certain proteins, genes, or other substances that help AML cells grow and spread.
Radiation therapy. It uses high-energy X-rays to kill cancer cells. The most common type for AML is external beam radiation, which comes from a machine outside your body. You might get this treatment before a stem cell transplant, or to kill leukemia cells in your brain.
Stem cell transplant. If you have high-dose chemotherapy, it can hurt your bone marrow. In that case, you might need a stem cell transplant afterward to replace your damaged marrow with healthy new blood-forming cells.
Doctors treat AML in two time periods, called phases:
Phase 1: Remission induction therapy. You get high doses of chemotherapy to kill as many cancer cells as possible in your blood and bone marrow. In some cases, you may also get targeted therapy drugs during this phase. Your goal is to get into remission, which means you no longer have signs of AML.
Phase 2: Post-remission therapy. During this period, you'll get more chemotherapy to kill any cancer cells that were left behind after phase one. Your goal is to cut the chances of your cancer coming back.
AML treatment can take many months. Some people will need to get treated for much longer to keep their cancer under control.
Where You Can Get Support
Your friends and family can be a huge help while you get treatment. A lot of times, they'll want to lend a hand but may not be sure what they should do. Feel free to give them specific requests when they ask how they can help.
Also turn to your medical team for advice and suggestions for support groups. If you join one, you can meet people who know just what you're going through and can offer tips and suggestions that have worked for them. Hospitals and organizations like the Leukemia & Lymphoma Society offer support groups for people with blood cancers and their families.
You can also ask your doctor to recommend a therapist or counselor. This mental health expert can suggest ways to help you deal the stress of your cancer and its treatments.