Acute myeloid leukaemia (AML) is a cancer that affects the blood and bone marrow (the part of the bone that produces blood cells). Myeloid leukaemias involve the overproduction of immature white blood cells called myeloblasts, preventing the bone marrow from making normal blood cells. AML develops quickly, with anaemia, bleeding and bruising occurring because of inadequate numbers of red cells and platelets. If untreated, AML can be rapidly fatal. In contrast, chronic myeloid leukaemia develops more slowly, and urgent treatment is usually unnecessary. There are at least eight different sub-types of AML.1
In Australia, 1,209 people were diagnosed with AML, and 1,319 died from this disease in 2024.2,3 AML was the nineteenth most common cause of death from cancer in Australia in 2024.4
Life can be difficult for people with AML. The disease makes people very sick and treatments such as chemotherapy have side effects that are often difficult to tolerate.5
3.5.6.1 Risk associated with smoking
Smoking is a cause of AML,6,7 and the risk increases with the number of cigarettes smoked and the duration of smoking.6 In the studies assessed by the 2004 Surgeon General’s report, the risk of AML for people with a history of smoking was 1.3 to 1.5-fold higher than the risk for those who had never smoked.6 A 2016 meta-analysis of 27 studies showed that people who currently smoke had a 1.36-fold higher odds of developing AML than those who never smoked, and that people who formerly smoked had a 1.21-fold higher odds compared to those who never smoked.8 A 2019 meta-analysis of 20 case–control studies, involving 7,538 people with AML and 137,924 healthy controls, showed a 1.42-fold higher odds of AML for people who currently smoke compared to those who never smoked.9
Smoking by parents is associated with childhood AML. One meta-analysis found a 1.34-fold increased odds of childhood AML with perinatal parental smoking.10
3.5.6.2 How tobacco smoke causes acute myeloid leukaemia
Cigarette smoke contains benzene, a known carcinogen that causes leukaemia.11 One study estimated that benzene from cigarette smoke was responsible for 12–58% of deaths from AML induced by smoking.12 A similar study from 2018 calculated that between 9% and 24% of smoking-associated deaths from AML were due to benzene.13 Polonium-210 and lead-210, both of which emit ionising radiation, are also found in cigarette smoke. Ionising radiation is a recognised cause of leukaemia, however more evidence is required to determine whether these elements are a cause of the leukaemias attributable to smoking.6,14
3.5.6.3 Factors affecting risk
Intensity and duration of smoking
The risk of AML increases with the intensity and duration of smoking.6 Findings from one meta-analysis showed that people who smoked for more than 20 years, over 20 cigarettes per day, or more than 20 or 40 pack-years all had a higher risk of developing AML relative to those who had smoked for less than 20 years, smoked fewer than 20 cigarettes per day, or fewer than 20 pack-years.8
Smoking cessation
The 2020 US Surgeon General’s report concluded that smoking cessation reduces the risk of AML,15 with the risk of AML declining with increasing time since smoking cessation. There was no reduction in risk for those who had quit within the past 10 years compared with those who continued smoking. However, the risk was lower for those who had quit for 10–20 years (odds ratio of 0.74) and even lower for those who had quit for more than 20 years (odds ratio of 0.59).15
3.5.6.4 Impact of smoking on prognosis
Smoking adversely impacts the survival time and treatment outcomes for people with AML. One study found that the average survival time for people with AML undergoing chemotherapy who never smoked was 60 months, compared to the 30-month survival time among those who currently or formerly smoked.16 Another study found that among people with AML undergoing chemotherapy, those who never smoked had a median overall survival of 24.5 months compared to 17.2 months among those who currently or formerly smoked.17 A small study of 148 patients undergoing stem cell transplantation for the treatment of AML found that smoking was associated with a greater hospitalisation time and poorer overall survival.18
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References
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14. US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease. A report of the US Surgeon General Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2010. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53017/.
15. US Department of Health and Human Services. Smoking cessation. A report of the Surgeon General. Atlanta, GA U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Centre for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 2020. Available from: https://www.cdc.gov/tobacco-surgeon-general-reports/reports/2020-smoking-cessation/.
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17. Kristensen D, Nielsen LB, Roug AS, Kristensen TC, El-Galaly TC, et al. The prognostic effect of smoking status on intensively treated acute myeloid leukaemia - A Danish nationwide cohort study. British Journal of Haematology, 2020; 190(2):236-43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32316076
18. Ehlers SL, Gastineau DA, Patten CA, Decker PA, Rausch SM, et al. The impact of smoking on outcomes among patients undergoing hematopoietic SCT for the treatment of acute leukemia. Bone Marrow Transplantation, 2011; 46(2):285-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20479707