Acute Myeloid Leukemia Survival Rates and Outlook

A diagnosis of acute myeloid leukemia (AML) can be scary. This rare cancer has a notoriously bad prognosis. According to the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) database, only 29.5% of people diagnosed with AML will be alive five years later.

But these survival rates always depend significantly on the patient's age, the disease's biological features, and other factors. For people 20 and older, the five-year acute myeloid leukemia survival rate is 26%, but for people under age 20, the AML survival rate jumps to 68%.

Though serious for many, especially patients over age 60, AML is treatable and potentially curable for younger people and those with certain disease subtypes. This article will explain acute myeloid leukemia's survival rate and outlook and highlight the nuances of how they are affected by age, AML type, and treatment response.

What is AML? 

AML is a type of cancer of the body’s blood cells. The blood contains multiple types of cells, including red blood cells (which carry oxygen to the body’s tissues) and white blood cells (which fight off invaders). 

These cells are made in the spongy tissue inside the bones, called bone marrow. Our bodies continually make them by stem cells that are constantly dividing and maturing into new cells.

AML is cancer that develops in the bone marrow cells that create white and red blood cells (myeloid hematopoietic precursor cells). When the cells become cancerous, they start to grow out of control and release immature or defective blood cells into the body.

AML can develop from cells that create white blood cells (this is most common) or those that create red blood cells or other cell types (less common). The type of cells that become cancerous in AML determines the diseases’ subtype. 

There are a few other names for AML, including:

• Acute myelocytic leukemia
• Acute myelogenous leukemia
• Acute granulocytic leukemia 
• Acute nonlymphocytic leukemia

The "A" in "AML" stands for acute. These cancerous cells are fast growing and spread quickly to the blood, lymph nodes, liver, spleen, brain, spinal cord, and testicles.

Doctors will diagnose about 20,000 new cases of AML yearly in the United States, and 11,400 AML patients will die from the disease. AML most often develops between the ages of 65 and 74. The average age at diagnosis is 68. Only about 4.4% of patients are under 20 years old when diagnosed, but these patients have the best survival rate. 

What Influences AML Survival Rate?

AML isn’t staged like other cancers since it doesn’t form solid tumors. It’s often widespread in the bone marrow and the blood when it’s first discovered and has sometimes spread to other organs as well. Instead, the subtype of AML plays a role in the survival rate and prognosis, as well as their age, general health, and results from other tests.

Doctors will typically label AML as one of these three stages:

• Favorable 
• Unfavorable
• Between favorable and unfavorable

About half of patients under age 60 with what's considered a favorable diagnosis will respond well to treatment in the long term. But for unfavorable diagnoses, less than 10% of patients younger than 60 will respond to treatment.

In addition to taking a health and family history, doctors will do several blood-based tests to determine your AML status. These include:

• White blood cell count will determine what progenitor cell has mutated and how the mutations change the cell types found in your blood. A high white blood cell count at diagnosis is also linked to worse outcomes.
• Gene mutation tests analyze the blood cells’ genes to determine which are mutated.
• Cytogenic analysis of chromosomal abnormalities looks at the changes to the genome on the chromosome level. Chromosomes are large molecules of DNA that hold many genes. Every cell in your body should have two copies of each of your 23 chromosomes. Sometimes parts of chromosomes can get erased, duplicated, flipped, or switched with a section of another chromosome while the cell is copying its genes.
• Tumor markers indicate changes to the characteristics of the cancerous cells, which can impact treatment and prognosis. 

Your age, general health, and various other factors will play into the survival rate and prognosis of your AML diagnosis. Research has linked several factors to a worse outlook for AML patients: 

• Having a high white blood cell count at diagnosis
• Having already had a blood disorder 
• Having been treated for another cancer
• Having a blood infection when diagnosed
• If the leukemia cells have spread to your brain or spinal cord

How Does Age Affect AML Survival Rate?

The younger an AML patient is, the better their outlook is. Patients over age 60 have a worse survival rate than those under 60 and make up a higher percentage of deaths from AML than those younger patients.

Older AML patients are more likely to have chromosomal abnormalities in their cancer cells that indicate a worse prognosis. 

In some cases, intensive chemotherapy treatments required to treat AML aren’t an option for a patient’s overall age and general health. Chemotherapy can negatively impact a patient’s immune system, which has already been weakened by the AML and generally degrades as a person gets older.

At some point, older age means the patient isn’t likely to tolerate treatment, and the best option is palliative care (measures to improve quality of life but are not expected to cure) or a weaker chemo regimen that may prolong survival.

How Does AML Type Affect AML Survival Rate?

AML subtypes are defined by the various changes to the cells that become cancerous. Doctors use one of two different staging systems to categorize AML subtypes.

The French-American-British (FAB) staging scale defines nine subtypes of AML: M0, M1, M2, M3, M4, M4eos, M5, M6, M7. These stages have been determined based on what type of cell becomes cancerous and how mature (or immature) the cancer cells are. The tests needed to assess cancer's FAB stage focus on how the cancer cells look under the microscope.

Many additional factors that impact a patient's prognosis are included in the World Health Organization's (WHO) classification stages. These molecular changes to cancer cells include gene mutations, chromosomal abnormalities, and tumor markers. There are seven subtypes of AML defined by the WHO classification system. 

The WHO staging system takes into account several molecular changes as the basis of these groupings. Some specific changes are related to a better prognosis, while others are related to a worse prognosis. 

Specific Gene Mutations

Mutations in these specific genes are linked to a better or worse prognosis:

• Mutations in the FLT3 gene have a generally poorer outlook, but new drugs are being developed with this target. 
• TP53, RUNX1, and ASXL1 gene mutations are linked to worse outlook.
• NPM1 and CEBPA gene mutations are often associated with a better prognosis.

Chromosomal Abnormalities

The movement of large sections of genes on various chromosomes can impact prognosis. Chromosomal abnormalities that result in better outcomes and prognosis include: 

• Movement of sections between chromosomes 8 and 21
• Movement of or flipping of sections of chromosome 16
• Movement of sections between chromosomes 15 and 17

Chromosome changes associated with worse outcomes, or unfavorable abnormalities, include:

• Deletions on chromosome 5 or 7
• Movement of or flipping of sections of chromosome 3
• Movement of sections between chromosomes 6 and 9
• Movement of sections between chromosomes 9 and 22
• Abnormalities in spot q23 of chromosome 11
• Loss of a copy of a chromosome (monosomy)
• Complex changes in three or more chromosomes

Doctors rate patients without cytogenic abnormalities as "between favorable and unfavorable." 

Tumor Markers

If doctors find proteins CD34 or p-glycoprotein on the outside of the cancer cells, these patients have a worse outlook.

How Does Response to Treatment Affect AML Survival Rate?

Another factor in your survival rate from AML is how well your disease responds to treatment. Treatments for AML include chemotherapy, which may be followed by a stem cell transplant or, in some cases, surgery or radiation. 

The better your AML reacts to treatment, the better your outcome is likely to be, such as:

• The best result of treatment is if you have no signs or symptoms of disease (complete remission) and cancer cells can’t be found through molecular methods (complete molecular remission).
• If after treatment you show minimal residual disease (MRD), which means they can detect cancer cells using sensitive molecular testing methods, you may be at risk of remission and a worse outcome or you may be put on prolonged or additional treatment cycles.
• The worst outcomes would be an active disease state after treatment, or if you return to an active disease state after remission.

Coping and Support

There are places to turn when it comes to coping with a disease with a low survival rate:

• Ask your care team for resources and support.
• Tell your family how you’re feeling. 
• Join support groups for AML patients.
• Find ways to relieve stress or take your mind off of your prognosis. 
• Make lists of questions for your doctors in advance. Bring someone with you to appointments to help you get clear answers and understand what the medical team is telling you. Take notes or record the appointments if reviewing the information later might help. 
• Look for online resources.

Summary

The prognosis for acute myeloid leukemia varies depending on age, subtype, and response to treatment. The best survival is in patients under age 20, with a five-year survival rate of 68%. For people 20 and older, the five-year survival rate is 26%.

Older AML patients are more likely to have chromosomal abnormalities in their cancer cells that indicate a worse prognosis. They may also not be able to tolerate the most aggressive treatments that have a better chance of leading to remission.

A Word From Verywell

Facing a diagnosis of AML can be difficult. While the overall survival rate is poor for AML patients, understanding how your specific characteristics may impact your specific prognosis may help you understand what to expect. 

Ask your healthcare providers and care team for help understanding your prognosis, and make sure you lean on them for support if you’re having trouble processing your diagnosis or outlook. They’re not just there to heal your body but also to support you and help you process during this troubling time.