Acute myeloid leukemia (AML) is a type of blood cancer. Most of the time, chemotherapy is the first treatment. AML is a fast-growing cancer, so treatment needs to be started quickly.
In chemotherapy, powerful drugs are used to destroy cancer cells. This aggressive cancer calls for intense chemotherapy, typically given in distinct phases.
In this article, we’ll look at the different phases of chemo for AML, which drugs are typically used, and what treatment is like.
Chemotherapy for AML is divided into three phases.
The first phase is short but intense, lasting about a week. The goals of induction are to:
- quickly clear leukemia cells from the blood
- get the number of blasts (immature cells) in the bone marrow into normal range
If you have other serious health conditions or are over age 75, your doctor may choose less intense chemo.
The consolidation phase starts once you’ve recovered from induction. Without it, leukemia is likely to return. The goal is to destroy any remaining leukemia cells that may escape detection. Treatment is given in cycles, with time for rest and recovery in between. Consolidation may last 3 to 6 months.
Maintenance or post-consolidation
The third phase is most likely to be used for a subtype of AML called acute promyelocytic leukemia (APL). It involves low-dose chemotherapy that may last for months or years.
For induction, the chemo drugs used most often are:
- cytarabine (also known as cytosine arabinoside or ara-C) given continuously for 7 days
- short infusions of an anthracycline drug, such as daunorubicin (also known as daunomycin) or idarubicin on each of the first 3 days.
This combination is known as a 7 + 3 regimen.
A third drug is sometimes added to boost the chance of remission. If you have an FLT3 gene mutation, you can take an oral targeted therapy drug called midostaurin (Rydapt) along with chemo. If you have the CD33 protein, the targeted drug gemtuzumab ozogamicin (Mylotarg) can be administered intravenously during your chemo session.
People with heart function problems may not be able to tolerate anthracyclines. Other chemo drugs, such as fludarabine (Fludara) or etoposide, can be used instead.
Other chemo drugs for AML include:
- 6-mercaptopurine (6-MP)
- 6-thioguanine (6-TG)
- cladribine (2-CdA)
- corticosteroids such as prednisone or dexamethasone
- methotrexate (MTX)
The consolidation phase may consist of three or four cycles of high-dose cytarabine, which is also known as HiDAC. It’s usually given over a period of 5 days and repeated every 4 weeks.
Some chemo drugs are injected or taken orally, but most are given intravenously. In rare cases when the cancer has reached the brain or spinal cord, chemo is delivered into the cerebrospinal fluid (CSF). Known as intrathecal chemotherapy, the medicine goes through a catheter that is inserted during a spinal tap, or lumbar puncture.
Induction chemotherapy is powerful and side effects can be serious. It’s administered in a hospital, where you may need to stay for several weeks.
During induction, most of your normal bone marrow cells are destroyed along with the leukemia cells. As a result, your blood counts may be very low. That’s why you might also need:
- blood product transfusions
- drugs to raise white blood cell counts
A low white blood cell count raises the risk of infection. You can reduce this risk while in treatment by washing your hands often and making sure your visitors do, too. Things to avoid include:
- fresh flowers and plants because they can expose you to mold
- uncooked fruits and vegetables
- people who are sick
After a few weeks, a bone marrow biopsy can determine if you’re in remission. If not, induction may be repeated before moving on to consolidation. Or your doctor may recommend a stem cell transplant at this time.
While destroying cancer cells, chemo drugs can destroy some healthy cells. This can cause a variety of side effects, depending on the drug, the dose, and length of treatment. Side effects may include:
- hair loss
- mouth sores
- dry eyes
- brittle fingernails and toenails
- poor appetite
- nausea and vomiting
- diarrhea or constipation
- coordination and balance problems
- shortness of breath
- easy bruising and bleeding
- increased risk of infection
Your oncology team will be able to treat many of these side effects. Most go away once you’re finished with chemo.
Chemo drugs can cause leukemia cells to break and spill their contents into the bloodstream. If the kidneys can’t filter these substances fast enough, they build up in the blood, a condition called tumor lysis syndrome.
This can strain the kidneys, heart, and nervous system. To help prevent this, your doctor may prescribe extra fluids and drugs such as:
Your oncology team will carefully monitor for serious side effects throughout chemotherapy. Drug dosages and timing can be adjusted when necessary.
Induction is successful if it results in remission.
According to the American Cancer Society, about 2 out of 3 people go into remission after standard induction chemotherapy. For those with APL, about 9 of 10 go into remission. With the consolidation and maintenance phases, about 8 or 9 of 10 people with APL experience long-term remission.
AML is sometimes curable.
These figures are a general overview, not your personal prognosis.
Survival rates are based on people who were diagnosed and treated at least 5 years ago. They don’t include the results of the most up-to-date treatments. Since 2017, the Food and Drug Administration has approved 10 new therapies for AML.
There are many prognostic factors involved. Your oncologist can help you understand more about what to expect from treatment.
Research and treatment for AML are advancing quickly. You might want to consider entering a clinical trial. Clinical trials are studies to assess the effectiveness of novel therapies that aren’t yet approved for general use. You can explore this with your oncologist, who can help guide you to more information.
A leukemia diagnosis can feel overwhelming at times. But you don’t have to go through this alone. Your oncology team is there to help. This is the time to lean on family and friends. And it sometimes helps to share feelings with others who are going through the same thing.
These organizations can help you find a support group that meets your needs:
AML is an aggressive blood cancer. Because it can progress quickly, treatment should begin as soon as possible. High-dose chemotherapy is a first-line treatment for most people with AML.
Chemotherapy for AML is intense, especially in the first phase. Side effects can be serious, so chemo takes place in a hospital setting where you can be closely monitored.
With treatment, long-term remission is possible.