Treatment for acute myeloid leukemia (AML) — or the subtype acute promyelocytic leukemia — is highly complex, so it’s important to be treated at a specialized center with expertise in AML.
Seattle Cancer Care Alliance (SCCA) experts offer comprehensive AML care, including advanced treatments and new options available only through clinical studies.
A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help.
- Phases of treatment
- Targeted therapy
- Bone marrow transplant
- Clinical trials
- Genetics clinic
- Next steps
AML expertise at SCCA
Higher leukemia survival rates
Data collected from cancer centers across the country show that people who begin their leukemia treatment at SCCA have higher survival rates on average than those who started treatment at other centers.
Everything you need is here
We have medical oncologists and hematologists who specialize in AML; the most advanced diagnostic, treatment and recovery programs; and extensive support.
Innovative leukemia therapies
SCCA is a world leader in leukemia research. Our doctors and scientists pioneered one of the most effective leukemia treatments — bone marrow transplant — and we advance new therapies every day.
Treatment tailored to you
We view treatment as a collaborative effort. Your SCCA doctor will explain all your options and recommend a treatment plan based on your AML subtype and classification, health, lifestyle and preferences.
Your personal team includes an oncologist, nurse case manager and team coordinator. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like an infectious disease doctor, pulmonologist, palliative care professional, geneticist, social worker, physical therapist or dietitian.
Ongoing care and support
After treatment, your team continues to provide follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life as an AML survivor.
Phases of AML treatment
Acute myeloid leukemia treatment is generally done in two phases.
Phase 1: induction therapy
The goals of induction therapy are to put your leukemia in remission and ensure you are healthy enough to go on to the next phase, consolidation therapy. This typically means getting a combination of chemotherapy drugs in the hospital for about a week. Some people need more than one course of induction therapy to bring about remission.
Your inpatient care will be at SCCA inpatient hospital at University of Washington Medical Center, which was named a Magnet hospital for its outstanding nursing care. Research shows patient outcomes are better at Magnet hospitals.
We know people prefer to be at home, so we provide as much of your care as possible as an outpatient. Offering infusion services 365 days a year at the SCCA outpatient clinic on Lake Union helps us keep your hospital stay shorter.
Phase 2: consolidation therapy
The goal of consolidation therapy is to eliminate any leukemia cells that remain. The main options for AML consolidation are chemotherapy or bone marrow transplant.
Chemotherapy for AML
Chemotherapy is the main treatment for AML. Doctors usually give a combination of several drugs.
Most chemotherapy drugs are given through an intravenous (IV) line in repeating cycles that range from two to six weeks.
Your SCCA team will talk with you about the specific drugs we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and connect you with medical and support resources throughout SCCA.
Some of the chemotherapy drugs most commonly used to treat AML include:
- Azacitidine (Mylosar, Vidaza)
- Cladribine (Leustatin)
- Cytarabine (Cytosar-U, Tarabine)
- Daunorubicin (Cerubidine, Rubidomycin)
- Decitabine (Dacogen)
- Etoposide (Toposar, VePesid)
- Fludarabine (Fludara)
- Idarubicin (Idamycin)
- Mitoxantrone (Novantrone)
Learn more about chemotherapy in our medical oncology section.
Targeted therapy for AML
Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells or they prompt your immune system to attack particular cells (also called immunotherapy).
Depending on the specific characteristics of your AML cells, one of these targeted therapies may be an option:
- Midostaurin (Rydapt) — if your cancer has an FLT3 gene mutation
- Enasidenib mesylate (Idhifa) — if your cancer has an IDH2 gene mutation
For people with CD33-positive AML, a targeted therapy called gemtuzumab ozogamicin (Mylotarg) may be an option. It uses an antibody to deliver an anti-cancer drug to your cancerous cells. Most AML cells have the CD33 protein that gemtuzumab targets.
Learn more about targeted therapies in our medical oncology section.
Bone marrow transplant for AML
Bone marrow transplants (also called stem cell or hematopoietic cell transplants) are most effective when AML is in remission. Researchers here developed a tool used worldwide that determines transplant risk to help your team make the best recommendation for you.
For AML, most people having a transplant get stem cells from a donor (allogeneic transplant). The transplant works in two ways.
- After you receive strong chemotherapy to eliminate the AML, the donor’s healthy stem cells restart your body’s ability to form blood cells.
- White blood cells from the donor may recognize as foreign and attack any leukemia cells that remain in your body.
More people are eligible for allogeneic transplants than ever before, due to advances available at SCCA, such as:
- Non-myeloablative (reduced-intensity) transplants, which use lower-dose chemotherapy
- Transplants using stem cells from donated umbilical cord blood or haploidentical (half-matched) donors
Less often, doctors transplant the patient’s own stem cells, which were removed earlier and purged of leukemic cells (autologous transplant).
Clinical trials for AML
For some people, taking part in a clinical study may be the best treatment choice. Access to clinical studies by researchers at SCCA and our founding organizations Fred Hutch and UW Medicine is one reason many patients come to SCCA.
Important areas of research for AML include new targeted therapies, transplants using stem cells from cord blood or half-matched donors, and immunotherapy to prevent relapse.
Treatment for acute promyelocytic leukemia (APL) differs from treatment for other subtypes of AML. If you have APL, it is important to receive care at an academic center like SCCA with expertise in this subtype to avoid complications in the early stages of treatment.
Results of a study of people with APL showed they fared considerably better if they were treated at a specialized center with AML expertise instead of at a center without this specialty.
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). Induction therapy results in complete remission in almost all people with APL.
Consolidation therapy for APL usually consists of chemotherapy and ATRA or ATO. You may need to be on this regimen for several months or up to a year.
Hematologic Malignancy Genetics Clinic
SCCA is one of only a few cancer centers in the nation to offer a Hematologic Malignancy Genetics Clinic. This program offers personalized risk assessment and follow-up care for adult patients and family members who may be at increased risk for developing hematologic malignancies due to an underlying genetic cause.
To schedule an appointment with the SCCA Hematologic Malignancy Genetics Clinic, call 1 (855) 557-0555.
Patients at risk for an inherited hematologic malignancy fit one of the following criteria:
- Have a personal or family history of long-standing blood count abnormalities of unknown cause
- Have a personal history of a blood cancer with close relative(s) who also have blood cancers
- Were diagnosed with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) before the age of 45
- Have a known familial marrow failure syndrome or an inherited predisposition to hematologic malignancy such as:
- Familial platelet disorder with propensity to myeloid malignancies (e.g., RUNX1 mutation)
- Familial MDS/AML (e.g., GATA2 mutation)
- Other known familial MDS/acute leukemia predisposition syndrome
- Telomere biology disorder or other inherited bone marrow failure condition (e.g., Diamond Blackfan anemia, Shwachman Diamond Syndrome)
- Have been referred to our clinic for evaluation by their provider
A visit to our hematologic malignancy genetics clinic includes the following services:
- Cancer risk assessment and genetic testing
- Cancer prevention counseling and strategies
- Evaluation to inform optimal hematopoietic stem cell transplant donor selection and preparatory regimen
- Long-term follow-up
The clinic is staffed by hematologist Siobán Keel, MD, medical geneticist Marshall Horwitz, MD, PhD, genetic counselor Mercy Laurino, MS, CGC, PhD and hematology nurse Amanda Weatherford, MS, RN, OCN.
- Make an appointment to see an SCCA leukemia expert.
- Learn about AML symptoms, diagnosis and subtypes.
- Read stories of people who've had AML.
- Find resources and support for new SCCA patients.