Acute myeloid leukemia

Treatment

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.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease.

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.

Hematologist A physician who specializes in diseases of the blood and blood-forming tissues.

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.

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets.

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.

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Team-based approach

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.

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Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Pulmonologist A physician who has special training in diagnosing and treating diseases of the lungs.

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.

Learn More about SCCA Survivorship Clinic

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at SCCA.

Phases of 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.

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Infusion An injection of medications or fluids into a vein over a period of time. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.

Phases of treatment

Acute myeloid leukemia treatment is generally done in two phases.

Chemotherapy

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)

Chemotherapy

Chemotherapy is the main treatment for AML. Doctors usually give a combination of several drugs.

Targeted therapy

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.

Antibody A protein made by immune system cells and released into the blood. Antibodies defend the body against foreign substances, such as bacteria. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.

Targeted therapy

Bone marrow transplant

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).

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.

Learn More About Bone Marrow Transplant

Bone marrow transplant

Treating APL

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.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.

Treating APL

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.

Learn More About Hematologic Malignancy Genetics Clinic

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