# Symptoms and disease progression of acute myeloid leukemia
Early phase: initial symptoms and diagnosis
In the early phase, people often notice sudden symptoms that develop because healthy blood cells are displaced by leukemic cells. The most common complaints are:
- **Fatigue and weakness** — caused by anemia, due to too few red blood cells
- **Bruising, nosebleeds and prolonged bleeding** — result of low platelet count
- **Infections and fever** — because there are too few healthy white blood cells to provide immunity
- **Pallor**
- **Shortness of breath** during exertion
- **Nausea and loss of appetite**
- **Abdominal pain** or feeling of fullness (from an enlarged spleen or liver)
- **Bone and joint pain**
In daily life this means someone tires much more quickly, normal work or household tasks become strenuous, and infections (flu, gum inflammation) feel severe and heal slowly.
These symptoms can develop rapidly, sometimes within days to weeks. A doctor makes the diagnosis through blood tests (in which abnormal young blood cells are visible) and usually bone marrow examination. At that point, the genetic abnormalities of the leukemic cells are also determined — this is important for treatment.
**Survival rates early phase:** This cannot be viewed separately from the further disease course; the diagnosis itself already determines much about the further progression. Individuals have very different starting positions depending on their age, overall health, and the genetic characteristics of their leukemia.
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Induction phase: intensive treatment
Once the diagnosis is confirmed, treatment usually begins immediately. For many patients this is intensive chemotherapy (induction chemotherapy), with the goal of killing as many leukemic cells as possible and restoring normal blood cell production.
**Physical symptoms and side effects:**
- **Severe nausea and vomiting** — very common, can last for weeks
- **Severe infection risk** — blood cells are further destroyed before new healthy cells grow; patients are highly susceptible to all types of infections
- **Severe fatigue** — almost total exhaustion
- **Oral mucositis** — painful ulcers in the mouth and throat that make eating and drinking difficult
- **Diarrhea**
- **Skin rash and red, swollen hands/feet**
- **Hair loss** (not always, depends on exact treatment)
- **Bleeding** before the platelet count recovers
**What this means in practice:**
The induction phase almost always requires hospitalization, usually for 4 to 6 weeks. Patients can eat almost nothing themselves, receive nutrition through infusion, have much pain, can barely get out of bed and are highly dependent on caregivers. Visits must be careful due to infection risk. It is emotionally and physically difficult.
After several weeks, blood tests follow to see if the leukemia responds. If the leukemic cells have largely disappeared and normal blood cells start to return, this is called **remission** or **complete response**. This is not a cure, but it is the first major goal.
**How long does this phase last and what are the survival rates?**
The induction phase typically lasts 4 to 8 weeks. Whether someone achieves remission depends on age, overall health, and genetic characteristics of the leukemia. For younger patients (up to about 60 years), approximately 75–85% achieve remission after initial treatment; for older patients this is lower (40–60%), partly because their body tolerates chemotherapy less well. These figures are population-wide averages (various sources, data from 2018–2023) and say nothing about any one person — much depends on individual factors that your treating physician knows.
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Consolidation and further treatment after remission
If remission is achieved, treatment usually continues to eliminate remaining leukemic cells (consolidation). This can be done in several ways:
- **Further chemotherapy rounds** (usually 2–4 additional rounds)
- **Stem cell or bone marrow transplantation** — especially for patients at high risk of relapse; the diseased bone marrow is first destroyed, then new marrow or stem cells are introduced
- **Maintenance therapy** — less intensive medication over months to years
Symptoms during consolidation resemble those of induction (risk of infection, fatigue, nausea), but are often somewhat less severe. Patients usually feel better as normal blood cells recover — energy returns, infections become less likely, appetite returns.
**Survival rates during consolidation phase:**
After successful induction and consolidation, approximately 45–55% of younger patients achieve long-term remission or cure (median follow-up 5 years and longer, various studies 2020–2024). For elderly patients or those with unfavourable genetic features, this percentage is lower. Again: these are population averages and say nothing about any individual patient.
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Relapse (recurrence) and treatment-resistant disease
Despite treatment, leukemia can return. This can happen:
- During or shortly after initial treatment (highly aggressive)
- Months or years later
- If the disease does not respond well to initial treatment
Symptoms of relapse resemble those at diagnosis: increasing fatigue, infections, bruising, fever.
**Treatment at relapse:**
There are more options nowadays than in the past. Depending on the situation and genetic features, the following may be used:
- Other chemotherapies
- Targeted drugs (e.g. against specific genetic abnormalities)
- Venetoclax (a drug used especially in elderly patients and certain types of leukemia)
- Stem cell transplantation (if not done initially)
The chance of long-term survival is lower than with initial treatment. Patients often feel weaker and experience more side effects.
**Survival rates at relapse:**
The median survival for patients with relapse is months to a few years, depending on how quickly relapse occurs and how well the disease responds to new treatment. Exact figures vary considerably by study population. These are very rough averages; individual situations vary greatly.
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Late phase: palliative care
If leukemia no longer responds well to treatment, the focus can shift to symptom management and quality of life rather than attempting cure. Doctors call this palliative care (not the same as end-of-life care; it can last months or longer).
**Symptoms in this phase: **
- Persistent fatigue
- Infections that are difficult to treat
- Weight loss
- Anaemia that keeps recurring despite transfusions
- Pain
- Breathing difficulties (from weakness or lung involvement)
- Confusion (from severe infection or leukemic cells in the brain — rare)
**In daily life:**
Patients become heavily dependent on care, cannot manage housework, need much help with washing and dressing. Much time is spent on hospital visits. The focus is on comfort, pain management and time with loved ones.
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When to contact your healthcare provider?
Always contact (emergency, general practitioner or hospital) if you:
- **Develop sudden, severe fever** (higher than 38.5°C) — this can indicate a life-threatening infection
- **See severe bleeding** (vomiting blood, black stools, bleeding that doesn't stop)
- **Experience severe shortness of breath** or pain
- **Have diarrhoea or vomiting with blood**
- **Faint or experience severe confusion**
- **Suddenly feel much worse during chemotherapy** without clear reason
Also for less severe but persistent symptoms (increasing fatigue despite rest, infections that don't heal), discuss this with your doctor — it may indicate the need for treatment adjustment.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._