Chemotherapy and Drug Therapy
Because of acute myeloid leukemia's (AML's) rapid growth, most patients need to start chemotherapy right away. During chemotherapy, you'll be given potent drugs that must be toxic enough to damage or kill leukemic cells. At the same time, they can take aim at normal cells and cause side effects. Yet, not everyone experiences side effects and people react differently.
AML treatment is generally done in two phases (cycles):
- induction therapy
- postremission (consolidation) therapy
The first phase of your treatment is induction therapy. Its goal is to "induce" (encourage) remission - when no evidence of the disease is left. Specifically, induction therapy attempts to:
- kill as many AML cells as possible with chemotherapy
- get blood cell counts back to normal
- get rid of all signs of the disease for an extended time
Induction therapy is done in the hospital usually over four to six weeks. You may have to go through several rounds of induction therapy before all your AML cells are destroyed and you go into remission.
Chemotherapy Drugs Used for AML
Doctors commonly combine two or more chemotherapy drugs to treat AML. Each drug type works in a different way to kill the cancerous cells. Combining drug types can strengthen their effectiveness.
Most AML patients are treated with a type of drug called an anthracycline, such as daunorubicin (Cerubidine®), doxorubicin (Adriamycin® PFS, Adriamycin®) or idarubicin (Idamycin®). Anthracycline is combined with cytarabine, also called cytosine arabinoside or ara-C (Cytosar-U®). Other drugs may be added or substituted for higher-risk, refractory or relapsed patients.
If you would like to read about these drugs individually, including information about side effects, click here.
You'll be given the drugs through a catheter (a thin, flexible tube or intravenous line) surgically placed in a vein, normally in your upper chest. You'll usually receive anthracycline in the first three days of treatment. You'll start the cytarabine at the same time but for a longer period of seven to 10 days. This treatment is called 7 plus 3.
The first round of chemotherapy doesn't always get rid of all AML cells. Most patients need more treatment. Usually the same drugs are used for more rounds of treatment.
After you finish induction therapy and are in remission, you'll need more therapy. This second phase of treatment is called postremission therapy. It's also known as consolidation therapy. Without this second step, your cancer will likely return.
Postremission therapy is meant to destroy stray AML cells not found by blood or marrow tests. You'll undergo postremission therapy in the hospital. The length of stay varies depending on the treatment and other factors. Postremission therapy includes chemotherapy and sometimes a stem cell transplant.
If you're not undergoing stem cell transplantation, you'll generally be given four cycles of chemotherapy. For best results, intensive chemotherapy is given with high doses of cytarabine or other drugs.
Central Nervous System Prophylaxis
In certain types of leukemia, particularly acute lymphoblastic leukemia and acute monocytic leukemia with high blood cell counts, the leukemic cells tend to enter the covering of the spinal canal and brain (the meninges). This results in central nervous system (CNS) AML.
This process often isn't apparent until months or years after remission when leukemia returns, first in the CNS coverings, then in the marrow and blood. To prevent this relapse (meningeal leukemia), virtually all children and adults with AML who enter remission are treated with CNS prophylaxis (a measure taken to prevent a disease). This postremission treatment involves placing chemotherapy in the fluid that bathes the spinal cord and brain. Chemotherapy drugs are delivered directly into your spinal canal during a procedure called intrathecal therapy.
CNS disease affects about one in 50 patients at the time of AML diagnosis. You may be more likely to have CNS AML if you have:
- a monocytic AML subtype, such as acute monocytic leukemia
- masses of AML cells outside your marrow
- an inversion of chromosome 16 and a translocation between chromosomes 8 and 21
- certain antigens (specifically, CD7- and CD56-positive [neural-cell adhesion molecules] immunophenotypes) on your cells' surfaces
- very high blood blast-cell counts at diagnosis
Your doctor may suggest you be tested using a lumbar puncture for CNS AML after your remission.
Additional Maintenance Therapy
Researchers are studying some forms of less intensive chemotherapy to help improve survival rates for patients after they finish postremission treatment. This type of low-dose chemotherapy is called maintenance therapy.
More to Explore
- Understanding chemotherapy
- Understanding intrathecal therapy
- Understanding lumbar puncture
- Tips to prevent and manage side effects
- Well-being during treatment
- Getting the proper food and nutrition during treatment
- Download or order The Leukemia & Lymphoma Society's free booklet Understanding Drug Therapy and Managing Side Effects