Cancer Leukemia Diagnosis What Are the Acute Myelogenous Leukemia (AML) Subtypes? By Karen Raymaakers linkedin Karen Raymaakers RN, CON(C) is a certified oncology nurse that has worked with leukemia and lymphoma patients for over a decade. Learn about our editorial process Karen Raymaakers Medically reviewed by Medically reviewed by Doru Paul, MD on November 18, 2019 Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology Oncology at the New York Presbyterian Weill Cornell Medical Center. Learn about our Medical Review Board Doru Paul, MD on November 18, 2019 Print Determining the type of acute myelogenous leukemia (AML) someone has is much like staging other cancers, like lung or breast cancer. In solid tumor cancers like these, staging is important to determine the extent of the disease, and to help plan treatment. In the case of leukemia, however, doctors will instead look at tissue samples from bone marrow aspiration and biopsy to determine the acute myelogenous (or myeloblastic) leukemia subtype, and then determine next steps. Hero Images / Getty Images What Determines a Type of AML? All blood cells, including red blood cells, platelets, and white blood cells, begin as a single stem cell in the bone marrow. Stem cells themselves do not have the ability to form clots, carry oxygen, or fight infection, but they develop or mature into fully functional blood cells that do. Stem cells grow into immature blood cells, which look and act a little more like the "adult" cell they will eventually become with each stage of development they go through. Once the blood cell is mature enough to carry out its role in the body, it is released from the bone marrow and into the bloodstream, where it will remain for the rest of its life. In the case of acute leukemia, there is an overproduction and release of very immature blood cells. The leukemia cells become "stuck" at one stage of development, and remain unable to do the function they are designed to do. Types are determined by what stage of development the cells stop at. There are two classification systems for identifying AML subtypes – the French-American-British (FAB) system and the World Health Organization (WHO) classification system. The FAB is the one most commonly used. To classify AML using this system, doctors will look at the leukemia cells they obtain during the bone marrow biopsy. Beyond determining what stage of development the cells are at, they will also determine what kind of cell they were supposed to become when mature. The chart below explains this system in greater detail. Why Does My AML Subtype Matter? Your AML subtype helps doctors to predict treatment, outcomes, prognosis, and behavior of your disease. For example, in a study published in 2015, researchers found that types M4, M5, M6, and M7 had the lowest survival rates. M4 and M5 subtype leukemia cells also are more likely to form masses called granulocytic sarcomas (lesions that form in soft tissue or bone) and to spread to the cerebrospinal fluid (CSF). Treatment is the same for most subtypes of acute leukemia with the exception of APL (M3). Different medications are used to treat APL, and the prognosis tends to be better than with other types of acute leukemia. The FAB Classification System Subtype Subtype Name Frequency Cell Characteristics M0 Myeloblastic 9- 12% Leukemia cells are extremely immature and do not have characteristics of the cell they were supposed to become. M1 AML with minimal maturation 16- 26% Immature myeloid cells (or myeloblasts/ "blasts") are the main type of cell in the marrow sample. M2 AML with maturation 20-29% Samples contain a lot of myeloblasts, but show more maturity than M1 subtype. Myeloblast is the last stage of development before the immature cell commits to becoming a white or red blood cell, or platelet M3 Promyelocytic (APL) 1-6% Leukemia cells are still immature, between the myeloblast and myelocyte stage. Very under-developed, but starting to look and act more like a white cell. M4 Acute Myelomonocytic Leukemia 16- 33% Leukemic cells are a mix of granulocytic and monocytic cell types The leukemia cells are looking more like white blood cells than the previous stage, but still very immature. M5 Acute Monocytic Leukemia 9- 26% More than 80% of the cells are monocytes. May be at different stages of maturity. M6 Acute Erythroid Leukemia 1-4% Leukemic cells are immature cells with characteristics of red blood cells. M7 Acute Megakaryocytic Leukemia 0-2% Leukemic cells are immature with characteristics of platelets. The Bottom Line Because leukemia cells travel quickly throughout the body, traditional methods for staging cancer do not apply. Instead, doctors look at physical and genetic features of your bone marrow cells to assign it into a subtype. These subtypes help doctors to determine what type of treatment will work best for you and also help to predict the outcomes of your treatment. Leukemia Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. Was this page helpful? Thanks for your feedback! Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Cancer Society. Acute Myeloid Leukemia (AML) Subtypes and Prognostic Factors. Updated August 21, 2018. Padilha SL, Souza EJ, Matos MC, Domino NR. Acute myeloid leukemia: survival analysis of patients at a university hospital of Paraná. Rev Bras Hematol Hemoter. 2015;37(1):21–27. doi:10.1016/j.bjhh.2014.11.008 Samborska M, Derwich K, Skalska-Sadowska J, Kurzawa P, Wachowiak J. Myeloid sarcoma in children - diagnostic and therapeutic difficulties. Contemp Oncol (Pozn). 2016;20(6):444–448. doi:10.5114/wo.2016.65602 American Cancer Society. Treatment of Acute Promyelocytic Leukemia (APL). Updated August 21, 2018.