Have you developed additional health issues after being diagnosed with acute myeloid leukemia (AML)? Blood cancers and their treatments can lead to complications — additional conditions that develop from a first disease. Some complications may develop months or even years after cancer treatment is completed.

Complications may lead to worse outcomes, make it harder to treat your AML, or affect your overall quality of life. Your health care team can help you manage complications, so make sure to tell your doctor about any health changes during or after AML treatment.

Learn to recognize some of the most common complications that can arise in people diagnosed with AML.

1. Anemia

Many people have low blood counts while living with AML. This common AML symptom develops when leukemia cells crowd out healthy blood cells, making it harder for your body to create more. Additionally, AML treatments often kill both cancerous and healthy blood cells.

As a result, you may experience anemia (low levels of red blood cells) while undergoing treatment. Red blood cell levels may also drop when you have a lot of cancer cells in your body, such as before treatment begins.

Symptoms of anemia include:

• Fatigue
• Lightheadedness
• Difficulty taking a deep breath
• Chest pain
• Skin that is paler than usual
• Cold hands or feet
• Heart palpitations (a fast or irregular heartbeat)

To lessen or prevent anemia during AML treatment, your doctor may give you red blood cell transfusions, which is when you receive healthy red blood cells from a donor. Transfusions are usually given when your hemoglobin levels reach 7 to 8 grams per deciliter.

2. Infections

AML can also lead to low levels of white blood cells. Because these immune cells are important for preventing and fighting infections, you may be more likely to get sick during leukemia treatment. Additionally, you may have a higher risk of infection if chemotherapy creates sores on the inside of your mouth or intestines, which makes it easier for bacteria or viruses to enter your body.

As you’re being treated for AML, tell your doctor right away if you experience potential symptoms of infection such as:

• Fever
• Chills
• Sore throat
• Coughing
• A stuffy or runny nose
• Painful or increased urination
• Vomiting
• Diarrhea
• Discoloration or swelling in your skin

Sometimes, you may not experience noticeable symptoms like fever, but if your tests show that your white cell count is too low, your doctor may start antibiotics to prevent you from catching an infection. Most guidelines recommend antibiotics when your neutrophils (a specific type of white blood cell that fights infection) fall below 500 cells per microliter.

3. Bleeding or Bruising

Platelets are cell pieces that help your blood clot. AML and its treatments may cause low levels of platelets, which can lead to unusual bleeding. For example, you may experience frequent nosebleeds, bleeding gums, heavy periods, or bleeding a lot after a small wound. You may also bruise more easily or have petechiae (discolored dots on your skin that can be red, purple, or brownish, depending on your skin tone).

Having low blood cell counts, including red blood cells, white blood cells, and platelets, is most common within the first month of treatment.

4. Tumor Lysis Syndrome

The goal of AML treatments is to kill as many leukemia cells as possible. However, you can develop tumor lysis syndrome (TLS) if too many cancer cells die too quickly.

When leukemia cells are destroyed, they release substances into your blood. Your kidneys can usually clear these substances away, but they may have a hard time doing so if large numbers of leukemia cells are killed all at once, leading to TLS. This complication may lead to symptoms like weakness, fainting, blood in your urine, nausea, vomiting, diarrhea, seizures, or an irregular heartbeat, which often develop within one to three days of starting chemotherapy. If left untreated, TLS can cause additional complications to develop, including kidney damage, kidney failure, heart disease, or an inability to control your muscles.

You are more likely to develop TLS if you have certain risk factors before treatment begins, including high white blood cell counts or high blood levels of certain chemicals such as lactate dehydrogenase (LDH), creatinine, or uric acid. Your doctor can give you medications like rasburicase (Elitek) or allopurinol (Zyloprim) to prevent or treat TLS. It’s also important to stay hydrated during chemotherapy, as hydration can prevent TLS.

5. Differentiation Syndrome

A differentiating agent is a medication that can help immature leukemia cells become more mature and effective blood cells. But it’s crucial to know that when using an AML treatment that includes a differentiating agent, there’s a risk of developing a condition called differentiation syndrome. These drugs include all-trans retinoic acid, ivosidenib (Tibsovo), and enasidenib (Idhifa). Differentiation syndrome often develops within a few days or weeks of starting treatment with these drugs. It happens during the treatment of a specific subtype of AML, known as acute promyelocytic leukemia.

During differentiation syndrome, your white blood cell counts soar too high, leading to fever, shortness of breath, and leg or arm swelling. This condition can be life-threatening, so tell your doctor right away if these symptoms occur while you’re taking differentiating agents.

6. Graft-Versus-Host Disease

An allogeneic bone marrow transplant is when healthy bone marrow (the spongy tissue found inside of certain bones) from a donor is used to replace the diseased bone marrow in a recipient. Graft-versus-host disease (GVHD) is a complication that may develop after an allogeneic bone marrow transplant. This type of treatment targets the cells in your bone marrow that make new blood cells. If you have AML, your bone marrow cells develop gene changes and produce cancerous blood cells in addition to healthy cells. During allogeneic transplantation, your cancerous bone marrow cells are killed with chemotherapy and/or radiation, and you then receive healthy cells from a donor.

After allogeneic transplantation, the donated bone marrow cells begin producing immune cells. These new immune cells may view the tissues throughout your body as foreign substances and attack them, leading to GVHD. This complication develops in about 35 percent to 45 percent of cases when the bone marrow cells come from a related donor, and in 60 percent to 80 percent of cases involving an unrelated donor.

Signs of GVHD include:

• Infections
• A rash or itching
• Discolored skin or yellow-tinted eyes
• Abdominal cramps
• Nausea or vomiting
• Dry eyes or mouth
• Joint pain
• Fatigue
• Weight loss
• Changes in how much you sweat

These symptoms may develop immediately after a transplant or up to several months afterward. Tell your doctor right away if you have previously undergone stem cell transplantation and you notice any of these symptoms.

Read more about GVHD.

7. Infertility

Multiple types of cancer treatments can affect your ability to have children in the future. This may be a “late” complication that you don’t discover until many years after treatment.

The following treatments may increase your risk of infertility:

• Chemotherapy drugs, especially alkylating agents like cyclophosphamide and procarbazine (Matulane) — These medications may damage sperm or egg cells.
• Radiation therapy — This treatment may lead to infertility if your testes or ovaries receive damaging doses of radiation, or if radiation treatments to your brain affect hormones that control reproduction.
• Bone marrow transplantation — This procedure often causes infertility because it requires high doses of chemotherapy or radiation.

Not all people who undergo these treatments become infertile. If you’d like to have children in the future, talk to your doctor about how your treatment plan will affect your fertility, and ask your health care team about fertility preservation options before treatment begins.

8. Other Potential Complications

You may develop other conditions as a result of AML symptoms or treatment side effects. In the short term, for example, you might feel tired or experience hair loss, vomiting, mouth ulcers, loss of appetite, or neuropathy (pain, tingling, or weakness in your feet or hands).

Other health issues can also develop many years after treatment ends. These may include:

• Ongoing fatigue
• Eye problems such as cataracts (a cloudiness in the lens of your eye)
• Lung damage
• Osteoporosis (thin bones)
• Thyroid conditions leading to low energy levels, feeling cold, and weight gain
• Heart problems
• An increased risk of second cancers
• Brain fog (difficulty remembering, focusing, or thinking clearly)

Teens and young adults who go through AML treatment are more likely to experience hormone problems like diabetes, respiratory issues such as asthma, neurologic problems like stroke, kidney problems, liver disease, and avascular necrosis (the death of bone tissue).

Discuss Complications With Your Doctor

When deciding on an AML treatment option, make sure to ask about the potential benefits and risks. Your health care team can help you understand what to expect while living with AML, going through treatments, and in the years afterward. Your doctor may also recommend therapies that help lessen your risk of certain complications.

If you’re concerned about the risk of complications or notice symptoms that may be related to a complication, talk to your doctor. They have all the details about your health and can help determine whether further testing or a change in treatment may improve your condition or help you feel your best.

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia and their loved ones. On MyLeukemiaTeam, more than 15,000 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Have you experienced complications from AML or its treatments? Has your doctor helped you find ways to treat or manage them? Share your experiences in the comments below, or start a conversation by posting on your Activities page.