Acute myeloid leukaemia in older people: symptoms, tests and treatment choices

Blood cells are made in the bone marrow, the soft, spongy tissue inside the bones. Cancer Research UK explains that in acute myeloid leukaemia the marrow makes too many early myeloid cells, which are not fully developed and cannot work normally. These abnormal cells crowd the marrow and block healthy blood cells from developing, so the body ends up short of working white cells, red cells and platelets.

The word acute describes how fast it can develop. The NHS describes AML as a rare cancer that usually develops quickly and needs to be treated straight away. It can be diagnosed at any age, but the risk rises with age, and the NHS lists being 60 or older among the things that make it more likely.

In practice, many older people also carry other conditions, such as heart or lung disease, and may be frailer than younger patients. That does not mean there is nothing to offer. It means the team has to weigh how much treatment the body can tolerate, which is why the idea of intensive versus non-intensive care sits at the centre of this topic.

The NHS says AML symptoms are not always obvious at first and can resemble other conditions. They usually appear over a few weeks. Many follow directly from the shortage of healthy blood cells: tiredness from too few red cells, infections from too few working white cells, and bruising or bleeding from too few platelets.

• Feeling very tired or weak, or looking paler than usual.

• Shortness of breath.

• Bleeding or bruising easily or for no reason.

• Getting ill a lot, or taking longer than usual to recover from illnesses, and a high temperature.

• Pain in the bones or joints.

• A swollen, uncomfortable or full tummy, and swollen glands in the neck, armpits or groin.

None of these symptoms proves leukaemia, and the NHS stresses that they are very common and can have many other causes. It nevertheless advises asking for an urgent GP appointment or getting help from NHS 111 if you have symptoms of acute myeloid leukaemia, because finding a cancer early means treatment is more likely to be successful.

The NHS says the GP will usually arrange an urgent blood test if there is a chance of AML, and may refer you for more tests or to a hospital specialist. Sometimes you might have to go to hospital straight away. Being sent quickly is a sign of caution, not a diagnosis. Older people sometimes put tiredness and breathlessness down to getting older; with AML, the speed of change over a few weeks is the feature worth reporting.

The NHS says it is not always clear what causes AML. It lists the following as raising the chance: being aged 60 or older, a genetic condition such as Down syndrome, another blood disorder such as chronic myeloid leukaemia, an autoimmune condition such as rheumatoid arthritis, past chemotherapy or radiotherapy, regular exposure to high levels of benzene (for example in some industries such as oil refineries), and smoking.

Cancer Research UK adds that AML can develop from a pre-existing blood condition called myelodysplasia, or arise after treatment for another cancer, which it calls secondary leukaemia. It says secondary leukaemia usually develops within 10 years of the first cancer treatment and that it may be harder to treat. Knowing this history helps the team choose a plan.

The NHS says the main tests are blood tests and a small sample taken from the bone marrow with a needle (a biopsy). For a bone marrow biopsy you usually have a local anaesthetic and may be given medicine to help you relax. You may get blood test results within days, but other tests can take a few weeks. The NHS tells people not to assume that a long wait means something is wrong, and that they can ring the hospital or GP for an update.

If AML is confirmed, further tests are usually needed. The NHS lists a lumbar puncture, scans such as X-ray, CT or ultrasound, more blood tests and a saliva sample, and says you may not need all of them. Cancer Research UK explains that gene changes in the leukaemia cells are part of what drives both treatment and outlook, and that bone marrow tests are repeated during and after treatment to look for measurable residual disease.

A group of specialists, called a multidisciplinary team, then looks after you. The NHS says this includes a clinical nurse specialist who is your main point of contact. Cancer Research UK says the team can also include consultant haematologists, dietitians, pharmacists, social workers and palliative care doctors and nurses.

Cancer Research UK explains that treatment depends on the type of AML, your age, general health and fitness, the white cell count at diagnosis, any gene changes in the leukaemia cells and where the leukaemia has spread. The main treatment in both routes is chemotherapy, sometimes with a targeted medicine.

Supportive treatments are part of both routes. The NHS lists antibiotics to prevent or treat infection, blood transfusions, growth factor medicines that help the bone marrow make blood cells, and treatment to remove high numbers of leukaemia cells. Cancer Research UK also mentions anti-sickness medicines, mouthwashes and painkillers for mouth sores, fluids through a drip, and dietitian input for appetite and weight loss.

The NHS notes that you will have regular check-ups during and after treatment, and that you do not need to wait for the next one if a symptom or side effect worries you. If the leukaemia cannot be cured, the aim becomes limiting it and its symptoms and helping you live longer, with a palliative care or symptom control team working alongside the haematology team to keep you comfortable and support those close to you.

Cancer Research UK is clear that no one can say exactly how long a person will live and that statistics are only a general guide. For all ages in England it reports that more than 40 in 100 people survive 1 year or more after diagnosis and more than 20 in 100 survive 5 years or more. Figures broken down by age come from one area of England: for people diagnosed with AML between 2010 and 2019, 5 in 100 aged 70 to 79 and 1 in 100 aged 80 and over survived 5 years or more.

Those numbers describe groups, many of whom could not have intensive treatment, and treatment has since changed. Cancer Research UK says improvements now make it possible to tailor treatment to individual situations and health. Ask your specialist what the figures mean for you, and what matters most to you in choosing between more intensive and gentler options.

AML is treated in haematology units through the NHS, with the diagnosis, treatment and supportive care described above provided free at the point of use. Some people also seek a private haematology opinion, for example to talk through treatment choices a second time. The tests and medicines used are essentially the same; the difference is mainly in how soon you are seen and which consultant you see. It is worth asking any team who will coordinate your care and who to contact if you become unwell between appointments.