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 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)

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.

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.

1. After you receive strong chemotherapy to eliminate the AML, the donor’s healthy stem cells restart your body’s ability to form blood cells.
2. 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). 

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.