AML Leukemia Treatment

Treating Acute Myelogenous Leukemia (AML)

Remission induction: This first part of treatment is directed at getting rid of all visible leukemia. It usually involves treatment with 2 chemotherapy drugs, cytarabine (ara-C) and an anthracycline drug such as daunorubicin or idarubicin (Daunomycin, Idamycin). Sometime a third drug, 6-thioguanine, is added. Some doctors are also adding gemtuzumab ozogamicin (Mylotarg). Another added drug might be one that stimulates white cell production. These are called granulocyte colony-stimulating factors (Neupogen, Leukine) and may improve the response to the chemotherapy. This intensive therapy, which usually takes place in the hospital, typically lasts one week.

Most of the normal bone marrow cells as well as the leukemic cells will be destroyed. During chemotherapy and the following couple of weeks, the patient's blood cell counts will be dangerously low, and supportive measures will be used to protect against complications. Usually, the patient stays in the hospital. If induction is successful, normal bone marrow cells will return in a couple of weeks and start making blood cells and no leukemic cells will be found in the blood. The number of blast cells in the bone marrow will be less than 5 %.

If one week of treatment does not induce remission, the process is repeated once or twice more. Induction is successful in about 65% of all AML patients. But this depends on a person’s specific prognostic factors (see above).

Remission induction usually does not destroy all the leukemia cells, as a small number often persist. Without more treatment, called consolidation, the leukemia is likely to return.

Consolidation (post-remission) therapy: This treatment is given after remission induction to destroy any remaining leukemia cells and prevent a relapse. The options for AML consolidation therapy are:

• several courses of high-dose cytarabine (ara-C) chemotherapy
• allogeneic (donor) stem cell transplantation
• autologous stem cell transplantation

High-dose consolidation chemotherapy differs from induction therapy in that usually only cytarabine (ara-C) is used. The drug is given at very high doses over 5 days. This process is repeated once or twice. Four years after this treatment, 40% of young patients (younger than 60 years) will not show any signs of leukemia. In older adults, this number is around 15%.

Another approach after successful induction therapy is stem cell transplantation. Patients first receive very high doses of chemotherapy to destroy all bone marrow cells. This is followed by either allogeneic (from a donor) or autologous (patient's own) stem cell transplantation to restore blood cell production. It is not clear which of the 3 treatment options (high-dose chemotherapy, allogeneic transplant, or autologous transplant) is best for consolidation. They each have their advantages and disadvantages.

Doctors look at several different factors when recommending what type of post-remission therapy a patient should receive. These include:

• How many courses (cycles) of chemotherapy it took to bring about a remission. If it took more than one course, some doctors recommend that the patient receive a more intensive program, which would involve a stem cell transplant.
• The availability of a brother or sister or an unrelated donor who matches the patient's tissue type. If a close enough tissue match is found then an allogeneic (donor) stem cell transplant is an option for post-remission therapy.
• The potential of collecting leukemia-free bone marrow cells from the patient. If cytogenic studies show that a patient is in remission, collecting stem cells from the patient's bone marrow or from peripheral blood for an autologous stem cell transplant procedure is an option for post-remission therapy. Stem cells collected from the patient would be purged (treated in the laboratory to remove or kill remaining leukemia cells) to lower the chances of relapse.
• The presence of one or more adverse prognostic factors, such as certain chromosome changes, a very high initial white blood cell count, AML that develops from a myelodysplastic syndrome or after treatment for an earlier cancer, or involvement of the central nervous system by AML. These factors might lead doctors to recommend more aggressive therapy, such as a stem cell transplant.
• The age of the patient. Older patients may not be able to tolerate some of the severe side effects that are sometimes seen with stem cell transplants. Therefore, this may not be as practical an option for them.
• The patient's wishes. There are many issues that revolve around quality of life that must be discussed. An important issue is the higher chance of early death from allogeneic transplant. This and other issues must be discussed between the patient and the doctor.

The role of stem cell transplantation in treating AML is a controversial topic. Some doctors feel that if the patient is healthy enough to withstand the procedure and a compatible donor is available, allogeneic transplantation offers the best chance for survival. Others feel that studies have not yet shown this conclusively. Because patients who have had this procedure have been younger and in better health, their improved survival might not be due to the procedure. That is, they might have done just as well with standard high-dose chemotherapy.

Maintenance therapy: In the past it was thought that a short burst of intense therapy as described above was the best way to treat AML. But a recent study from Germany of over 800 patients found that patients had better outcomes if they also received low doses of chemotherapy for 3 years after their induction and consolidation courses.

American Cancer Society

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If you or a loved one have been diagnosed with any of the following leukemia's, then please contact us immediately:

• Aplastic Anemia (AA)
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• Myelodysplastic Syndrome (MDS)
• Non-Hodgkin's Lymphoma (NHL)

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