Treatment options and prognosis for acute myeloid leukemia (AML) depend on the AML subtype, treatment response, and risk stratification; your white blood cell count; and your age and overall health.
The main types of treatment for AML are:
- Bone marrow transplant
Treatment for the acute promyelocytic leukemia (APL) subtype is different than for other types of AML.
In addition, supportive treatments are routinely used, including antibiotics to reduce the chance for bacterial or fungal infections and platelet transfusions to lower the risk of bleeding.
Standard therapy has been given to so many patients that the results can be predicted with some confidence; however, given the highly complex treatment protocols for AML, we believe it is important to be treated at a specialized center with AML expertise. In fact, results of a study of people with the APL subtype demonstrated that those treated at specialized centers with expertise in AML fared considerably better than those treated at centers without this specialty.
Phases of Treatment
AML treatment is generally done in two phases:
- Induction therapy
- Consolidation therapy
Induction is the first phase of treatment. The goals of induction therapy are to achieve remission—no more than 5 percent leukemic cells in the bone marrow, return of normal marrow cells, and normal blood counts—and to ensure the patient is healthy enough after induction therapy to go on to consolidation therapy, which is more intensive. A combination of two or more chemotherapy drugs is the main induction therapy for AML. This phase of treatment is usually given in the hospital and lasts about a week.
About a week or so after completion of induction therapy, a bone marrow biopsy will be taken to evaluate how effective the treatment was at putting the leukemia in remission. Sometimes more than one course of induction therapy is needed to bring about remission.
Consolidation is the second phase of treatment for people with AML. It is given when you have recovered from induction therapy. The goal of consolidation is to eliminate any leukemia cells that remain (known as minimal residual disease, or MRD) after induction therapy. Patients who don’t receive consolidation therapy often relapse.
The main options for AML consolidation are chemotherapy—for about three to four months—or a bone marrow transplant.
Treatment for APL differs from treatment for other types of AML. It is important for people with APL to be treated at academic centers with expertise in this disease to avoid complications in the early stages of treatment.
Typically, induction therapy for APL includes a nonchemotherapy drug called all-trans retinoic acid (ATRA), also called tretinoin (Vesanoid), in combination with either chemotherapy or arsenic trioxide (ATO, Trisenox). ATRA is taken by mouth in capsule form; ATO is given by infusion through an intravenous (IV) line. Induction therapy results in complete remission in almost all people with APL.
Consolidation therapy for this disease usually consists of chemotherapy and ATRA or ATO. This regimen may be continued for several months or up to a year.
Potential Side Effects from Treatments for APL
Side effects of ATRA and ATO vary greatly from person to person. Your treatment team can tell you about the side effects that are most common with your drugs.
Potential side effects of the drugs include differentiation syndrome—an excessive inflammatory response, which may lead to breathing problems from fluid building up in your lungs, severe fluid buildup and swelling in other parts of your body, low blood pressure, and damage to your kidneys. In addition, ATO may cause QT prolongation (heart rhythm problems), unusual bruising or bleeding, seizures, increase in blood sugar (hyperglycemia), nausea, vomiting, diarrhea, and fatigue.
Let your team know about any side effects you experience. They may be able to give you medicines to prevent or relieve side effects, suggest other ways to manage side effects, or change your dosage or treatment schedule to prevent side effects from getting worse.
Treating AML in the Central Nervous System
Spread of leukemia into the brain and spinal fluid (central nervous system, or CNS) is rare in people with AML. If CNS involvement is confirmed, treatment typically includes chemotherapy injected directly into the cerebrospinal fluid (intrathecal chemotherapy) to target the brain and spinal cord. If there is evidence of nerve damage, radiation to the brain or spinal canal may also be prescribed.
Access to clinical studies conducted by researchers at Seattle Cancer Care Alliance (SCCA) founding organizations—Fred Hutch, UW Medicine, and Seattle Children’s—is one reason why many people come to SCCA for treatment. The goal of clinical studies, also known as clinical trials, is to develop more effective lifesaving treatments in the fight against leukemia. Areas of investigation for treating AML include the evaluation of new drugs or combinations of drugs, including targeted agents that can be given with or without bone marrow transplantation; transplants using stem cells from cord blood or haploidentical (half-matched) donors; and immunologic approaches to prevent relapse.
For some people, taking part in a clinical study may be the best treatment choice. At any time, SCCA has studies ongoing that are evaluating new treatments for AML. Be sure to ask your doctor if a clinical study is right for you. For more information about participating, see our patient guide to clinical studies.