While AML is considered a rare disease overall, the sobering reality that it strikes an estimated 20,380 people in the US each year makes its profound impact undeniable.
Key Takeaways
- Approximately 20,380 new cases of AML diagnosed in the US in 2023
- AML accounts for about 1.3% of all new cancer cases in the US
- Median age at diagnosis for AML is 68 years
- Prior chemotherapy exposure increases AML risk 10-fold
- Smoking doubles AML risk in heavy smokers
- Radiation exposure (e.g., atomic bomb survivors) raises AML risk 10-50x
- Fatigue is the most common symptom in 90% of AML patients
- Anemia present at diagnosis in 85-90% of cases
- Bone marrow blasts ≥20% defines AML diagnosis
- Induction chemotherapy CR rate 60-80% in young patients
- 7+3 regimen (cytarabine + daunorubicin) standard for fit patients
- Venetoclax + HMA CR/CRi 67% in unfit elderly
- 5-year survival 10-20% over age 65
- Favorable cytogenetics: 5-year OS 50-70%
- Adverse risk: median OS 8-12 months
AML is a rare but serious cancer primarily affecting older adults, with over 20,000 new U.S. cases annually.
Incidence and Prevalence
- Approximately 20,380 new cases of AML diagnosed in the US in 2023
- AML accounts for about 1.3% of all new cancer cases in the US
- Median age at diagnosis for AML is 68 years
- Incidence rate of AML is 4.1 per 100,000 men and women per year based on 2017–2021 data
- AML is the most common acute leukemia in adults
- Globally, there were about 147,000 new AML cases in 2020
- AML incidence increases with age, peaking after 65 years
- In children, AML represents 15-20% of all leukemias
- US death rate for AML is 2.7 per 100,000 men and women per year
- AML comprises 80% of acute leukemias in adults
- Lifetime risk of developing AML is 0.5% (1 in 200)
- Annual incidence in Europe is about 3.7 per 100,000
- AML incidence in Japan is lower at 2.4 per 100,000
- Prevalence of AML in US adults over 65 is higher than younger groups
- 5-year relative survival for all AML stages is 31.9%
- AML represents 1.2% of all leukemia cases
- Incidence in African Americans is 4.5 per 100,000 vs 4.0 in whites
- Pediatric AML incidence is 0.9 per 100,000 children
- AML cases in US men: 11,300 annually
- AML cases in US women: 9,080 annually
- Global AML mortality was 111,000 in 2020
- AML incidence rose 3% annually from 2001-2019 in some regions
- 1.8% of cancer deaths in US are from AML
- AML is rare under age 40
- SEER data shows 10,550 deaths from AML in 2021
- AML accounts for 0.9% of all new cancer cases and deaths
- Incidence higher in Hispanics at 4.3 per 100,000
- AML in adolescents/young adults: 1.1 per 100,000
- 80-90% of AML cases occur in adults over 60
- AML smoking-attributable fraction is 18%
Incidence and Prevalence Interpretation
While AML may be a statistical rarity overall, it's a devastatingly common foe for adults over 60, claiming its highest toll just as many are looking forward to retirement, with a survival rate that underscores the urgent need for progress.
Risk Factors and Causes
- Prior chemotherapy exposure increases AML risk 10-fold
- Smoking doubles AML risk in heavy smokers
- Radiation exposure (e.g., atomic bomb survivors) raises AML risk 10-50x
- Down syndrome increases AML risk 10-20 times
- Benzene exposure risk ratio for AML is 1.4-3.8
- Myelodysplastic syndromes (MDS) precede 30% of AML cases
- Obesity associated with 20-40% increased AML risk
- Family history increases risk 2-4 fold in relatives
- TP53 mutations found in 30% of therapy-related AML
- Male gender has 25% higher AML incidence than females
- Fanconi anemia patients have 500-1000x AML risk
- Chronic myelomonocytic leukemia (CMML) progresses to AML in 15-30%
- Pesticide exposure OR=1.2-2.0 for AML
- Age over 65 is strongest risk factor, RR>10
- Genetic syndromes like Klinefelter increase risk 4x
- Topoisomerase II inhibitors cause 25% of therapy-related AML
- Alcohol consumption >45g/day increases risk by 22%
- RUNX1 mutations in 10-15% familial AML cases
- Hairy cell leukemia transformation to AML rare, <1%
- Solvent exposure meta-analysis OR=1.3 for AML
- CEBPA mutations in 10% de novo AML, hereditary form rare
- Prior Hodgkin lymphoma treatment: 1-5% develop AML
- GATA2 germline mutations cause 15% familial MDS/AML
- Arsenic exposure in water linked to 1.5x AML risk
- DOCK8 deficiency: 20% develop AML
- Alkylating agents cause 50-70% therapy-related AML
Risk Factors and Causes Interpretation
The unsettling résumé for acute myeloid leukemia reveals it is an opportunistic disease that preys on both the profound vulnerabilities of genetics and the accumulated insults of modern life, from workplace toxins to medical treatments themselves.
Survival Rates and Prognosis
- 5-year survival 10-20% over age 65
- Favorable cytogenetics: 5-year OS 50-70%
- Adverse risk: median OS 8-12 months
- NPM1 mutated without FLT3-ITD: 5-year OS 60%
- FLT3-ITD high allelic ratio: 5-year OS <20%
- ELN 2022 favorable risk: 5-year survival 60%
- Core binding factor AML: 5-year OS 70%
- TP53 mutated: median OS 5 months
- Post-HSCT relapse-free survival 50% at 3 years
- Pediatric AML 5-year survival 70%
- Secondary AML median OS 8 months
- MRD negative post-induction: OS doubled
- Age <60 favorable: 5-year OS 40-50%
- Complex karyotype (>3 abnormalities): OS <10% at 5 years
- Intermediate risk 5-year OS 30-40%
- 1-year survival overall 38%
- Monosomal karyotype: 4% 5-year survival
- IDH1/2 mutated better prognosis with inhibitors, OS +6 months
- APL subtype 90% curable with ATRA+ATO
- Elderly unfit median OS 3-5 months BSC
- HSCT in CR1 improves 3-year OS 55% vs 35% chemo
- RUNX1 mutated: median OS 12 months
- Overall 5-year survival improved from 24% to 30% 2013-2019
- t(8;21) favorable: 70% 5-year EFS
- ASXL1 mutation worsens prognosis, HR=1.8
- Relapsed AML median OS 4-6 months
- MRD+ post-consolidation: relapse risk 50-80%
Survival Rates and Prognosis Interpretation
Even with a five-year survival rate that can feel like a cruel roll of the dice—from a bleak 4% to a hopeful 90%—your specific genetics, age, and response to treatment ultimately write your personal prognosis, for better or worse.
Symptoms and Diagnosis
- Fatigue is the most common symptom in 90% of AML patients
- Anemia present at diagnosis in 85-90% of cases
- Bone marrow blasts ≥20% defines AML diagnosis
- Thrombocytopenia in 70-80% at presentation
- Flow cytometry detects abnormal myeloid markers in 95% accuracy
- Fever/infection in 50-60% due to neutropenia
- Cytogenetic analysis prognostic in 90% of cases
- Easy bruising/bleeding in 50% of patients
- Leukocytosis >100,000 in 20% hyperleukocytosis cases
- Bone pain reported in 25-40% of patients
- PET/CT sensitivity for extramedullary disease 80%
- Gum hypertrophy in monocytic AML (FAB M4/M5) 20-40%
- Molecular testing for NPM1 in 30-35% favorable cases
- Shortness of breath from anemia in 60%
- Splenomegaly in 20-30% at diagnosis
- Next-gen sequencing detects mutations in 90% AML
- Weight loss/unintentional in 20%
- Lymphadenopathy rare, <10%
- HLA typing for transplant in 100% eligible patients
- Skin involvement (leukemia cutis) in 10-15% M4/M5
- Median WBC at diagnosis 15,000-100,000/uL
- MRD assessment by flow in 70-80% sensitivity post-induction
- Gingival bleeding common in thrombocytopenia
- Hepatomegaly in 10-20%
- FLT3-ITD mutation testing in all patients
- Night sweats in 25%
- Central nervous system involvement <5%
- Complete remission defined as <5% blasts
Symptoms and Diagnosis Interpretation
AML is a brutal arithmetic where the most common symptom is the exhaustion of fighting it, nearly everyone is anemic at diagnosis while blast counts define the war, and though the disease loudly announces itself through bleeding, fever, and pain, our most critical weapons—from cytogenetics to sequencing—are the precise intelligence gathering that makes remission a target we can actually hit.
Treatment and Outcomes
- Induction chemotherapy CR rate 60-80% in young patients
- 7+3 regimen (cytarabine + daunorubicin) standard for fit patients
- Venetoclax + HMA CR/CRi 67% in unfit elderly
- Allogeneic HSCT relapse rate 30-50% at 2 years
- Midostaurin improves OS in FLT3-mutated AML by 22%
- Gemtuzumab ozogamicin OS benefit 15% in favorable risk
- CPX-351 CR 48% vs 33% in secondary AML
- Azacitidine median OS 10.4 months in unfit patients
- Quizartinib PFS 8.5 months in FLT3-ITD relapsed
- Intensive chemo mortality 1-5% induction
- HMA + venetoclax OS 14.7 months unfit elderly
- Auto-HSCT used rarely, <10% AML patients
- Ivosidenib ORR 42% IDH1-mutated relapsed
- Enasidenib ORR 40% IDH2-mutated relapsed
- Glasdegib + LDAC OS 8.8 vs 4.5 months
- CAR-T limited data, response in 50-70% refractory
- Maintenance azacitidine post-HSCT reduces relapse 30%
- CRp rate with HMA alone 20-30% unfit
- Targeted therapy access improved outcomes 20% since 2017
- Relapse occurs in 50-70% after first CR
- Hypomethylating agents used in 40% newly diagnosed unfit
- HSCT in first CR: 50-60% LFS favorable risk
- Oral azacitidine maintenance PFS doubled
- Gilteritinib ORR 52% FLT3 relapsed/refractory
- Intensive therapy CR 70% under 60 years
- Supportive care: platelet transfusion threshold 10,000/uL
Treatment and Outcomes Interpretation
We have become adept at threading a therapeutic needle, balancing hopeful remission rates against sobering relapse risks, all while an expanding arsenal of targeted agents slowly reshapes the odds for patients both young and old.
Sources & References
- Reference 1CANCERcancer.govVisit source
- Reference 2CANCERcancer.orgVisit source
- Reference 3SEERseer.cancer.govVisit source
- Reference 4LLSlls.orgVisit source
- Reference 5NCBIncbi.nlm.nih.govVisit source
- Reference 6MAYOCLINICmayoclinic.orgVisit source
- Reference 7PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 8MSKCCmskcc.orgVisit source
- Reference 9NEJMnejm.orgVisit source