Understanding Bone Pain in AML

Some patients with acute myeloid leukemia (AML) experience pain, which can impact their quality of life. Bone pain is a symptom of AML that can result from the build-up of abnormal white blood cells in the bone marrow, causing the bone marrow to expand. Additionally, abnormal cells may gather close to the surface of bones or within joints, which can lead to joint pain. 

Bone pain in patients with AML can be sharp or dull, varying depending on the affected location. The severity may be different from person to person. While bone pain can occur in adults, it is more common in children with AML as their bone marrow is much more active than in adults.     

Most Commonly Affected Areas

Bone pain in patients with AML typically affects bones with large amounts of bone marrow. Some of the common areas of the body affected include:

• Legs
• Arms
• Hips
• Sternum
• Ribcage

Joint pain typically develops later than bone pain in patients with AML and commonly affects:

• Wrists 
• Ankles 
• Hips 
• Shoulders 

What are the signs that bone pain is AML-related?

Bone pain caused by AML can be misinterpreted as arthritis in adults or growing pains in children and teenagers. Patients should contact their medical team if the pain is severe, worsening, or continuous. Bone pain usually differs from muscle pain as it tends to linger, even while inactive. It is particularly important for a patient to contact a healthcare professional if they experience bone pain with additional symptoms of AML, as it might be key for earlier diagnoses or earlier detection of progression. 

Treatment-related bone pain

In addition to AML causing bone pain, some types of treatment for AML may also induce bone pain. Treatment-related bone pain usually differs from bone pain caused by AML as it is widespread soreness felt in multiple regions rather than distinct areas of the body. 

If you have finished your AML treatment and experience bone pain, it is not necessarily a sign of relapse, as it may have been caused by the treatment itself. Chemotherapy, radiation therapy, tyrosine kinase inhibitors (midostaurin or gilteritinib), and treatment with granulocyte colony-stimulating factor (G-CSF) can cause bone pain. Patients should always report side effects from treatment to healthcare professionals.

Bone pain management

The severity of bone pain in patients with AML can vary. Pain management strategies, such as anti-inflammatory drugs, corticosteroids, antihistamines, nerve blocks, specialized injections, neuropathic pain medications, and low-dose radiation, may alleviate this pain and improve the patient's quality of life. Keeping active and living a healthy lifestyle can be beneficial for patients with AML and may help reduce pain. 

Key takeaways about AML-related bone pain

• Bone and joint pain can be a symptom of AML and generally affects larger bones and joints.
• Bone and joint pain is more common in children with AML.
• Common therapies used to treat AML may also cause bone pain.
• There are several strategies to help patients cope with pain, including medications and lifestyle adjustments. 

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Sources:

• Acute leukemia presenting as bone pain with normal white blood cell count
• Bone and Joint Pain – Part 1
• Symptoms of Leukemia