Acute myeloid leukemia (AML) is often treated in two phases, induction therapy and postremission (consolidation) therapy.
What is Chemotherapy?
- Chemotherapy is the use of potent drugs or chemicals, often in combinations or intervals, to kill or damage cancer cells.
- Chemotherapy can be hard on the body: The drugs’ toxicity can also damage or kill healthy cells and cause side effects.
- Everyone experiences side effects differently.
AML treatment is generally done in two phases (cycles):
Treatment for patients with acute promyelocytic leukemia (APL), the M3 subtype of AML, differs from other AML treatments. Click here to read about treatment for APL.
AML patients whose leukemia cells have certain genetic mutations are assigned a specific risk status. Talk to your doctor about treatments available to target specific genetic mutations. See the LLS fact sheet, Cancer Molecular Profiling.
The first phase of your treatment is induction therapy. Its goal is to "induce" (bring on) remission (when no evidence of the disease is left). Specifically, induction therapy for AML attempts to:
- Kill as many AML cells as possible with chemotherapy
- Get healthy blood cell counts back to normal
- Get rid of all signs of the disease for an extended time
What type of treatment is used for AML induction therapy?
- Doctors commonly combine two or more chemotherapy drugs to treat AML. Each type of drug works in a different way to kill the cancerous cells. Combining drug types can strengthen their effectiveness.
- Most AML patients are treated with a combination of an anthracycline (such as daunorubicin [Cerubidine®], doxorubicin [Adriamycin® PFS, Adriamycin®] or idarubicin [Idamycin®]) and cytarabine (also called cytosine arabinoside or ara-C [Cytosar-U®]).
- Gemtuzumab ozogamicin (MylotargTM) is FDA approved for the treatment of adults with newly diagnosed AML whose tumors express the CD33 antigen (CD33-positive AML).
- Midostaurin (Rydapt®) is FDA approved for the treatment of newly diagnosed adult patients with AML that is FLT3 mutation positive as detected by an FDA-approved test, in combination with standard cytarabine and daunorubicin induction and cytarabine consolidation. It is not indicated as a single-agent induction therapy for the treatment of patients with AML.
- Daunorubicin and cytarabine (Vyxeos™) is FDA approved for the treatment of adults with newly-diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC).
- Venetoclax (Venclexta®), in combination with azacitidine or decitabine or low-dose cytarabine for the treatment of newly-diagnosed acute myeloid leukemia (AML) in adults who are age 75 years or older, or who have comorbidities that preclude use of intensive induction chemotherapy.
- Glasdegib (DaurismoTM), in combination with low-dose cytarabine, for the treatment of newly-diagnosed acute myeloid leukemia (AML) in adult patients who are ≥75 years old or who have comorbidities that preclude use of intensive induction chemotherapy.
- Other drugs may be added or substituted for higher-risk, refractory or relapsed patients.
- For information about the drugs mentioned on this page, visit Drug Listings.
- For a list of standard drugs and drugs under clinical study to treat AML, download or order The Leukemia and Lymphoma Society's free booklet, Acute Myeloid Leukemia.
After induction therapy is complete and the patient is in remission, there will be another phase of treatment is needed called “postremission therapy,” or “consolidation therapy.” This second phase of treatment is used to destroy any stray AML cells not found by blood or marrow tests. Without postremission therapy, the AML will likely return.
What type of treatment is used for AML postremission therapy?
- Postremission therapy consists of additional intensive chemotherapy after remission has been achieved, with or without stem cell transplantation. If stem cell transplantation is not used, the treatment will generally consist of four cycles of chemotherapy. For best results, intensive chemotherapy is given with high doses of cytarabine or other drugs.
Where is the treatment done?
- Postremission therapy happens in the hospital and the length of stay depends on the treatment and other factors.
Central Nervous System (CNS) Prophylaxis
CNS prophylaxis is a postremission treatment used to prevent central nervous system (CNS) AML.
What is central nervous system (CNS) AML?
- CNS AML, or meningeal leukemia, is when AML spreads to the meninges (the covering of the spinal cord and brain).
- CNS AML has a tendency to occur in patients with acute lymphoblastic leukemia and acute monocytic leukemia
- It is not common for CNS AML to be present at the time of initial AML diagnosis, and it more commonly occurs in the form of relapse (the cancer returns after the patient is in remission).
Who is treated with central nervous system (CNS) prophylaxis?
- Preventative therapy is usually not indicated for CNS AML but examination of the spinal fluid after remission should be considered for some patients.
What type of treatment is used for CNS prophylaxis?
- Chemotherapy drugs are injected into the spinal fluid (fluid that surrounds the spinal cord and brain), using a treatment called intrathecal therapy.
- Chemotherapy and Other Drug Therapies
- Lumbar puncture
- Managing Side Effects
- Integrative Medicine and Complementary and Alternative Therapies
- Food and Nutrition
- Download or order The Leukemia & Lymphoma Society's free booklet Understanding Side Effects of Drug Therapy