Secondary acute myeloid leukaemia (AML)
Acute myeloid leukaemia (AML) is a fast-growing blood cancer. Secondary AML is when AML develops from other cancers or their treatment. Find out about the signs and symptoms, who it might affect and how it is diagnosed and treated.
Summary
- Secondary acute myeloid leukaemia (AML) is when AML develops from other cancers or after treatment for cancer.
- It is usually diagnosed from blood tests and bone marrow tests.
- Your doctor will recommend treatment based on your needs. You might have intensive or non-intensive treatment.
- Intensive treatment involves chemotherapy. It’s usually a treatment called liposomal daunorubicin and cytarabine.
- Non-intensive treatment is gentler. It involves low-dose chemotherapy or targeted medicine.
- It can be hard dealing with side effects and treatment. Ask your friends, family, medical team or Leukaemia Care if you need support.
About secondary AML
AML is a fast-growing blood cancer. It develops when blood-forming cells grow out of control. They can build up in your bone marrow and stop it making enough healthy blood cells.
Often, we don’t know exactly what causes AML. But sometimes it happens as a result of something else. This is secondary AML. It can develop:
- After treatment for a different cancer.
- From another type of blood cancer. This is usually myelodysplastic syndrome (MDS) or a myeloproliferative neoplasm (MPN).
Secondary AML affects fewer than 900 people a year in the UK. It happens because blood cancers and cancer treatments can damage the cells in your bone marrow.
Signs and symptoms of secondary AML
The signs and symptoms of secondary AML include:
- Fatigue
- Infections
- Feeling breathless
- Bruising or bleeding
- Fever
- Bone pain
- Low red blood cell count (anaemia)
- A swollen spleen or liver
Some people might not have any new symptoms. You may be diagnosed after routine tests for your other cancer.
The diagnosis is confirmed using blood tests and bone marrow tests.
Treating secondary AML
Your medical team will recommend treatment based on your needs. This might be intensive or non-intensive treatment.
We have separate information on different treatments. This includes how you have them and possible side effects.
Intensive treatment
Intensive treatment involves chemotherapy. It is usually a treatment called liposomal daunorubicin + cytarabine. It’s also known as CPX-351 or Vyxeos.
- You have it through a drip into a vein, or a central line if you have one. You usually have it as a hospital outpatient. You have treatment in cycles, with time in between for your bone marrow to recover.
- You may also have a targeted medicine. This depends on the genetic changes in your leukaemia cells.
- Some people might have a stem cell transplant. This is a very intensive form of treatment. It is not suitable for everyone. Your medical team will explain if it’s an option for you.
Sometimes your team might recommend a different type of chemotherapy. They will explain what treatment they recommend, where you will have it, and what you can expect from it. For some treatments, you may need to stay in hospital.
Non-intensive treatment
Non-intensive treatment is gentler. It aims to control your AML as much as possible. But it does not cure it. It usually involves low-dose chemotherapy or targeted treatment to take at home.
Secondary AML can be difficult to treat. Outcomes vary from person to person. Your medical team are best placed to discuss what they expect for you.
It can be hard dealing with treatment and its side effects. Don’t be afraid to ask for help from family, friends, your medical team or Leukaemia Care.
Sources we used to develop this information
Bhatia S. Therapy-related myelodysplasia and acute myeloid leukemia. Seminars in Oncology. 2013 Dec 1;40(6):666-675.
Döhner H, Wei AH, Appelbaum FR, Craddock C, DiNardo CD, Dombret H, Ebert BL, Fenaux P, Godley LA, Hasserjian RP, Larson RA. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood. 2022 Sep 22;140(12):1345-77.
Dunbar AJ, Rampal RK, Levine R. Leukemia secondary to myeloproliferative neoplasms. Blood. 2020 Jul 2;136(1):61-70.
Haematological Malignancy Research Network (HMRN) – Incidence statistics: https://hmrn.org/statistics/incidence [Accessed Jan 2025]
Heuser M, Ofran Y, Boissel N, Mauri SB, Craddock C, Janssen J, Wierzbowska A, Buske C. Acute myeloid leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2020 Jun 1;31(6):697-712.
Lancet JE, Uy GL, Newell LF, Lin TL, Ritchie EK, Stuart RK, Strickland SA, Hogge D, Solomon SR, Bixby DL, Kolitz JE. CPX-351 versus 7+ 3 cytarabine and daunorubicin chemotherapy in older adults with newly diagnosed high-risk or secondary acute myeloid leukaemia: 5-year results of a randomised, open-label, multicentre, phase 3 trial. The Lancet Haematology. 2021 Jul 1;8(7):e481-91.
Lancet, J.E., Uy, G.L., Cortes, J.E., Newell, L.F., Lin, T.L., Ritchie, E.K., Stuart, R.K., Strickland, S.A., Hogge, D., Solomon, S.R. and Stone, R.M., 2018. CPX-351 (cytarabine and daunorubicin) liposome for injection versus conventional cytarabine plus daunorubicin in older patients with newly diagnosed secondary acute myeloid leukemia. Journal of Clinical Oncology. 2018;36(26):2684-2692.
Legg A, Ellison T, O’Connell M, Evans M. Analysis of treatments and outcomes for patients with de novo AML, therapy-related AML, and secondary AML (prior MDS and CMML) diagnosed in England between 2011–2016 using Hospital Episode Statistics©. InPoster presented at: 25th Congress of the European Hematology Association (EHA) 2020 Jun 11 (pp. 11-14).
Martínez-Cuadrón D, Megías-Vericat JE, Serrano J, Martínez-Sánchez P, Rodríguez-Arbolí E, Gil C, Aguiar E, Bergua J, López-Lorenzo JL, Bernal T, Espadana A. Treatment patterns and outcomes of 2310 patients with secondary acute myeloid leukemia: a PETHEMA registry study. Blood Advances. 2022 Feb 22;6(4):1278-95.
Menssen AJ, Walter MJ. Genetics of progression from MDS to secondary leukemia. Blood, The Journal of the American Society of Hematology. 2020 Jul 2;136(1):50-60.
Ossenkoppele G, Montesinos P. Challenges in the diagnosis and treatment of secondary acute myeloid leukemia. Critical Reviews in Oncology/Hematology. 2019 Jun 1;138:6-13.
Strickland SA, Vey N. Diagnosis and treatment of therapy-related acute myeloid leukemia. Critical Reviews in Oncology/Hematology. 2022 Mar 1;171:103607.
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This information is aimed at people in the UK. We do our best to make sure it is accurate and up to date but it should not replace advice from your health professional. Find out more about our information.
Page last reviewed: 28 February 2025
Updated January 2026
Next review due: 29 February 2028
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