Leukemia--Acute Myeloid (Myelogenous) Overview

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Treating Leukemia - Acute Myeloid (AML) TOPICS

Chemotherapy for acute myeloid leukemia

Chemotherapy (chemo) is the use of drugs to kill or control 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 spine (CSF), the drugs may be given directly into the CSF. This isn’t common in the treatment of AML.

Chemo for acute myeloid leukemia (AML) usually involves 2 or 3 anti-cancer drugs given for 5 to 7 days.

Treatment of AML is divided into 2 phases:

  • Induction (or remission induction)
  • Consolidation (post-remission)

For some types of AML, there is a third phase: maintenance.

Induction

The goal of this first phase is to clear the blood of leukemia cells (blasts) and to reduce the number of blasts (very immature cells) 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.

During this time and in the weeks right after, the patient's blood cell counts will be very low. The doctor will take measures to protect against problems. If one week of chemo does not kill most of the cancer cells (bring about a remission), more chemo may be needed. The success rate for induction varies widely and depends on each person's own case.

Induction usually does not kill all of the leukemia cells. Without more treatment, called consolidation, the leukemia is likely to return in a few months.

Consolidation (post-remission) therapy

While the first phase of treatment usually kills nearly all of the cancer cells, there may still be a small number of "hidden" leukemia cells. The purpose of the second phase is to kill these cells and keep the cancer from coming back (relapsing). The options for consolidation treatment are either more chemo or a stem cell transplant (described later). What treatment is given depends on a number of factors, including the type of leukemia and the patient’s prognostic factors (these were discussed in the section “How is acute myeloid leukemia classified?”).

Stem cell transplants (SCT) have been found to reduce the risk of leukemia coming back more than standard chemo, but they are also more likely to cause serious problems which can even include death. That’s why doctors may give SCTs only to patients whose AML is more likely to come back.

Treating frail, older adults

Treatment of AML in people under 60 is fairly standard. It involves cycles of intense chemo (discussed above). Many patients older than 60 are healthy enough to be treated in the same way, although sometimes the chemo may be less intense. People who are much older or are in poor health may not be able to take this intense treatment. In fact, intense chemo could actually shorten their lives.

In some cases, doctors may recommend less intense treatment. In some cases, this may induce remission. In others, it may control the leukemia for a time. 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 a drug more often used to treat another disease called myelodysplastic syndrome, like azacitidine (Vidaza®) or decitabine (Dacogen®). These drugs are not approved to treat AML, but still may be helpful.

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.

Maintenance

Maintenance involves giving a low dose of a chemo drug for months or years after consolidation is finished. This is often used for one type of AML (AML M3), but it is rarely used for other types.

Side effects of chemo

Chemo drugs work by killing 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, 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 may include:

  • Hair loss
  • Mouth sores
  • Loss of appetite
  • Nausea and vomiting
  • 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, there are drugs than can be taken along with the chemo to prevent or reduce nausea and vomiting. Drugs known as growth factors are sometimes given to keep blood counts higher and reduce the chance of infection.

If your white blood cell counts are very low during treatment, it increases the 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 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. These "waste" chemicals 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, testes, ovaries, brain, heart, and lungs. By watching the patient carefully, the doctor may be able to prevent many of these side effects. If serious side effects happen, though, the 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 our document, Leukemia–Acute Myeloid (Myelogenous).

Our document, Understanding Chemotherapy: A Guide for Patients and Families has more information about chemo and its side effects.


Last Medical Review: 06/27/2013
Last Revised: 02/07/2014