Because of acute myeloid leukemia's (AML) rapid growth, most patients need to start chemotherapy right away.
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):
- Induction therapy
- Postremission (consolidation and maintenance) therapy (will be anchor links)
- Central nervous system prophylaxis
- Additional maintenance therapy
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.
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®]).
Other drugs may be added or substituted for higher-risk, refractory or relapsed patients.
How are these drugs administered?
- These drugs are administered through a catheter (a thin, flexible tube or intravenous line, which is surgically placed in a vein, normally in the upper chest). The anthracycline is usually given in the first 3 days of treatment. The cytarabine is started at the same time but is given for 7 to 10 days. This treatment is called “7 plus 3”.
Where is the treatment done?
- Induction therapy happens in the hospital, usually over 4-6 weeks. You may have to go through several rounds of induction therapy before you go into remission. Usually the same drugs are used for more rounds of treatment.
- 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.
- For information about the drugs mentioned on this page, visit Drug Listings.
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 includes chemotherapy and sometimes a stem cell transplant. 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).
- Patients may be more likely to have CNS AML if they have:
- A monocytic AML subtype, such as acute monocytic leukemia
- Masses of AML cells outside the 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 cells' surfaces
- Very high blood blast-cell counts at diagnosis
- After a patient reaches remission, their doctor may suggest they be tested for central nervous system (CNS) AML, using a lumbar puncture.
Who is treated with central nervous system (CNS) prophylaxis?
- To prevent this relapse, almost all children and adults with AML who enter remission are treated with 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.
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.
- 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