Chemotherapy (chemo) is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. These drugs enter the bloodstream and go throughout the body. If leukemia cells are found in the fluid around the brain and spinal cord (CSF), the drugs may be given directly into the CSF. This isn’t common in the treatment of acute myeloid leukemia (AML).
Chemo is the main treatment for most people with AML.
Treatment of AML is typically divided into 2 phases:
- Induction (or remission induction): The goal of this first phase is to clear the blood of leukemia cells (blasts) and to reduce the number of blasts in the bone marrow to normal. It usually involves treatment with 2 or 3 chemo drugs that are given while the patient is in the hospital. It takes about a week to give the chemo, and then often the patient stays in the hospital for a few weeks longer. In rare cases where the leukemia has spread to the brain or spinal cord, chemo may be given into the CSF as well.
- Consolidation (post-remission): The purpose of this second phase is to kill any remaining leukemia cells and keep the AML from coming back (relapsing). The options for consolidation treatment are either more chemo or a stem cell transplant.
For the acute promyelocytic leukemia (APL) subtype of AML, there is a third phase:
- Maintenance: This involves giving low doses of chemo drugs (or other drugs) for months or years after consolidation is finished.
Treating frail, older adults
People who are elderly or are in poor health may not be able to get intense chemo. In fact, it might actually shorten their lives. In some cases, doctors may recommend less intense treatment. Treatment of these patients is often not divided into induction and consolidation, but may be given every so often as long as it seems helpful.
Sometimes, these patients may be treated with drugs more often used to treat another disease called myelodysplastic syndrome, which might have fewer side effects.
Some patients decide against chemo and other drugs and instead choose supportive care. This focuses on treating any symptoms or problems that arise and keeping the person as comfortable as possible.
Side effects of chemo
Chemo drugs kill cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are likely to be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and how long they are taken. These side effects can include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Diarrhea or constipation
- Greater chance of infection (due to a shortage of normal white blood cells)
- Easy bruising or bleeding (due to a shortage of blood platelets)
- Tiredness (due to a shortage of red blood cells)
Most of these side effects go away after treatment ends. And there are often ways to manage these side effects during treatment. For example, drugs can be taken along with the chemo to prevent or reduce nausea and vomiting.
If your white blood cell counts are very low during treatment, it increases your risk of serious infection. Your doctor may tell you to take special steps to avoid germs. Antibiotics are often given before there are signs of infection or as soon as it looks like one may be starting.
If your platelet counts are low, you might get platelet transfusions to help prevent bleeding. Low red blood cell counts, causing shortness of breath and tiredness, can be treated with drugs or with transfusions.
Tumor lysis syndrome is a side effect caused by the rapid breakdown of leukemia cells during treatment. It is most common during the first treatment (induction), when the patient has the highest numbers of leukemia cells. When these cells die, they break open and release their contents into the bloodstream, which can affect the kidneys, heart, and nervous system. Extra fluids or certain drugs that help rid the body of these substances can help prevent this problem.
Organs that could be damaged by chemo include the kidneys, liver, testicles, ovaries, brain, heart, and lungs. By watching the patient carefully, the doctor may be able to limit many of these side effects. If serious side effects happen, though, the chemo drugs may have to be given at lower doses or even stopped. Be sure to tell your doctor about any problems you have.
For more details about the treatment of AML, see Leukemia–Acute Myeloid (Myelogenous).
Last Revised: 02/22/2016