Measuring your response to AML treatment

• Your hospital team will monitor how your AML treatment is working.
• Tests will check if the level of leukaemia cells in your blood is falling.
• Your treatment may adjust to keep your blood count within safe levels.
• Our Support Service can explain the different types of remission.

You’ll have regular blood tests to check if the leukaemia, or the treatment, is affecting your healthy blood cells. If this happens, you might need a red blood cell or platelet transfusion.

We explain about blood counts and how everyone has slightly different numbers of each type of blood cell below.

You’ll also have regular blood tests to check that your liver and kidneys are working well, as these are often affected by leukaemia treatment.

AML starts in the bone marrow, so checking the bone marrow for leukaemia cells (blasts) is an important test. A bone marrow test will usually be done as part of the initial process of diagnosing AML. You are also likely to have further bone marrow tests during and after treatment. Comparing the results at different times will show how well the treatment is working.

A bone marrow biopsy involves removing a sample of bone marrow from your hip bone. When looked at under a microscope, this can show how many leukaemia cells (blasts) are in your bone marrow, and whether you are in remission.

Blasts are very young blood cells. They can either be normal or part of the leukaemia. If they are normal, they are usually found in the bone marrow, where they grow into fully functioning blood cells, which then move into the bloodstream to do their jobs in the body. In healthy people, less than 5 out of every 100 (5%) of the bone marrow cells are blasts.

In AML, blasts do not develop fully and they build up. This means there are lots of immature blasts in your bone marrow and blood – these are the leukaemia cells.

Blasts are also called myeloblasts.

Tests to monitor how well your treatment is working will look at:

• how many blasts (leukaemia cells) are in your bone marrow
• whether you have enough healthy blood cells of all types.

In someone healthy, the bone marrow contains less than 5% blasts and there would not be any in the blood. In AML, there can be high numbers of blasts in the bone marrow and the blood.

Your doctors will use blood tests and bone marrow biopsies to measure how many blasts you have. AML is usually diagnosed if the number of blasts is between 1 in 10 (10%) and 2 in 10 (20%) or more. When treatment is working, this number will go back down.

Doctors use tests to check if you are in remission from AML. You might hear your hospital team use different words to describe the type of remission. We explain these terms below.

AML and its treatment can reduce the number of healthy blood cells you have.

There are three main types of blood cell – red blood cells, white blood cells and platelets. They all do different important jobs in the body. There are several different types of white blood cells, including neutrophils, lymphocytes and monocytes.

Your doctors will measure the levels of key blood cells. They want to keep your blood counts within safe limits. So, if they find the counts are too low for one or more types of blood cell, they may:

• adjust your treatment
• give you a red blood cell or platelet transfusion.

Everyone has slightly different numbers of each type of blood cell. If you’re healthy, your blood counts will normally fall within the ranges we mention below. But blood counts can vary depending on your sex, age and ethnicity. For example, people from African Caribbean heritage have slightly lower blood counts than those who are white.

Ask your hospital team what your blood test results and numbers mean. They know what’s normal for you.

• Red blood cells – Your doctors will look at your levels of haemoglobin. This is a substance found in red blood cells that carries oxygen. In someone healthy, this level can range from 115 to 180 (measured in grams per litre). You will usually need a blood transfusion if this level goes below 80.
• Platelets – In someone healthy, the level of platelets can range from 150 to 400 (measured in billion cells per litre). If this level goes below 10, you might need a platelet transfusion.
• White blood cells – In someone healthy, this level can range from 4 to 11 (measured in billion cells per litre). Leukaemia cells are a type of white blood cell, so when somebody is first diagnosed with AML the levels can be very abnormal.
• Neutrophils – Neutrophils are healthy white blood cells that protect you against infection. For a healthy person, the level can range from 2 to 7.5 (measured in billion cells per litre). Most leukaemia treatments make the number of neutrophils go down, and intensive treatments can make it go down to zero for several weeks. This is called neutropenia. During this time, you are at high risk from infections. You’ll need strong antibiotics if you get an infection. When the neutrophil count goes back up, your body is better able to fight infections by itself.
• Lymphocytes – For this other type of white blood cell, the level can range from 1.5 to 4.5 (measured in billion cells per litre). Lymphocyte levels are usually less affected by AML treatment than other blood cell types.