Secondary acute myeloid leukemia (AML) is a blood cancer that arises from other blood disorders or previous cancer treatment. Those with secondary AML tend to have a less favorable outlook than those with primary AML.

Acute myeloid leukemia (AML) is classified as primary, or “de novo,” if it develops in people without a history of another blood disorder or cancer treatment. Secondary AML either develops from previous cancer treatment with chemotherapy and radiation therapy or from preexisting blood conditions, such as:

  • aplastic anemia
  • myelodysplastic syndromes
  • chronic myeloproliferative syndrome
  • myelodysplastic/myeloproliferative overlap syndromes

Read on to learn more about secondary AML, including its symptoms, treatment options, and outlook.

Secondary AML is estimated to account for about 20% to 30% of AML cases.

As with other cancers, AML develops when genetic changes to cells cause them to replicate uncontrollably. In people with secondary AML, these changes occur in immature myeloid blood cells due to previous cancer treatment or another blood disorder. Myeloid blood cells become:

  • platelets
  • red blood cells
  • some types of white blood cells

Secondary AML caused by previous cancer treatment is also called therapy-related AML, or t-AML. Between 5% and 10% of AML cases are t-AML.

People at risk of secondary AML include those with other blood disorders as well as those who have received previous chemotherapy or radiation therapy for other cancers.

Secondary AML can develop from:

  • Aplastic anemia: Aplastic anemia is a rare condition in which your bone marrow doesn’t produce enough new blood cells.
  • Myelodysplastic syndromes: Myelodysplastic syndromes are a group of conditions that impair your body’s ability to make healthy blood cells.
  • Chronic myeloproliferative syndrome: This is a condition in which your body produces too many red blood cells, white blood cells, or platelets.
  • Myelodysplastic/myeloproliferative overlap syndromes: These have features of both chronic myeloproliferative syndrome and myelodysplastic syndromes.

General AML risk factors

General AML risk factors include:

  • older age
  • male sex
  • smoking
  • exposure to certain chemicals like benzene
  • exposure to some chemotherapy drugs or radiation therapy
  • having a family history or some genetic conditions

The symptoms of secondary AML are similar to those of primary AML. They include:

The overproduction of abnormal and immature blood cells in people with AML can crowd out healthy blood cells. This overcrowding, as well as treatment for AML, can lead to many problems, including:

  • weakened immune system
  • frequent and easy bleeding
  • frequent and easy bruising
  • infertility (due to chemotherapy)

The signs and symptoms of leukemia are often general and mimic those of many common conditions like the flu. It’s important to get medical attention if you have concerning symptoms that persist for more than a couple of weeks, such as unexplained:

  • weight loss
  • loss of appetite
  • fatigue
  • fever
  • night sweats

Your doctor might suspect secondary AML if you have a previous history of cancer treatment or associated blood disorders. Initial tests for secondary AML usually consist of:

  • a review of your symptoms
  • a review of your personal and family medical history
  • blood tests to look at your blood cell counts and whether you have abnormal blood cells

The diagnosis of secondary acute myeloid leukemia requires a bone marrow biopsy. This involves taking a sample of the tissue inside your bones that creates blood cells.

Other tests you might receive include:

The most common treatment options for secondary AML include:

  • chemotherapy
  • hematopoietic stem cell transplant
  • targeted therapy drugs like janus kinase inhibitors or venetoclax (Venclexta, Venclyxto)

The FDA approved Vyxeos in 2017 for treating secondary AML. It’s the current standard treatment for people fit enough to undergo chemotherapy. This medication is administered by IV, typically through 90-minute infusions. It consists of the two chemotherapy drugs daunorubicin and cytarabine.

Chemotherapy is often combined with an allogeneic stem cell transplant for eligible people. An allogeneic stem cell transplant involves taking stem cells from the bone marrow of a donor and infusing them into your blood to help your body produce more healthy blood cells.

The outlook for people with secondary AML tends to be worse than for those with primary AML, especially people with other blood disorders.

The 5-year overall survival rate for secondary AML is under 30%, meaning fewer than 30% of people are still alive 5 years after their diagnosis.

Having certain genetic mutations is associated with a better outlook. These mutations include an inversion of chromosome 16 and a translocation of chromosomes 15 and 17.

Secondary AML is largely not preventable. You may be able to lower your chances of developing it by reducing your chances of developing other cancers that might require radiation therapy or chemotherapy. You may be able to do this by:

What are the types of secondary AML?

Secondary AML is divided into two main types. It’s called therapy-related AML when it’s linked to previous cancer treatment and AML with myelodysplastic-related changes when linked to previous blood disorders.

Can secondary AML be cured?

Secondary AML often isn’t considered curable, but some people go into complete remission with chemotherapy and a stem cell transplant. Complete remission is when all signs and symptoms of your cancer disappear.

What is the life expectancy of someone with secondary acute myeloid leukemia?

Fewer than 30% of people diagnosed with secondary acute myeloid leukemia are alive 5 years later.

Secondary AML is a type of blood cancer that develops in people who have received previous cancer treatment or have a history of blood disorders that cause cells to divide too quickly.

The outlook for people with secondary AML tends to be worse than for people with primary AML, but some people go into complete remission with a combination of chemotherapy and a stem cell transplant.

It’s important to speak with your doctor any time you develop potential warning signs of leukemia, such as unexplained shortness of breath, fatigue, and weight loss.