A study of 3363 Swedish AML registry patients found that about three-quarters of all cases of AML arose de novo, without leukemogenic exposure. Secondary AML, related to prior hematologic disorders (eg, myelodysplastic syndromes [MDS]), was reported for about 1 in 5 patients with AML. Therapy-related AML, which can occur subsequent to radiation or chemotherapy, occurred in approximately 8% of patients.1
In the majority of cases, patients with de novo AML have no specifically identifiable risk factors.3 The following provides some examples of factors that seem to be related:
Age
The median age of diagnosis is 68 years.4 As of 2018, the incidence of AML tends to increase with age, from 1.3 cases per 100,000 population in patients <50 years old, to 19.4 cases per 100,000 population in patients ≥65 years.5
Sex and Ethnicity
AML is more common in men than women.1,6 People of white race/ethnicity have a higher incidence compared to other racial and ethnic groups.4
Prior Chemotherapy
Patients treated with chemotherapy for various malignancies have an increased risk of developing acute leukemia. Risk of leukemia varies according to the underlying disease, specific agents (eg, alkylating agents, topoisomerase II inhibitors, antimetabolites), timing of exposure, and dose.2,7
Familial Risk Factors
Though fairly uncommon, there are genetic syndromes that increase the risk of developing AML including Down syndrome, bone marrow failure syndromes, and Li-Fraumeni syndrome.8 In addition, familial myeloid malignancies, including myelodysplastic syndromes (MDS) and AML, have been identified. More than 20 different genes have been implicated, but the prevalence of familial AML remains unclear.9
Lifestyle Risk Factors
Smoking.2
Environmental Risk Factors
Chemical exposure (eg, benzene) and ionizing radiation exposure.2