Treatment of AML
The treatment of AML is very complex and time consuming. Chemotherapy is the most important method of treating this illness.
There are three basic stages of treatment for AML:
- Remission induction
- Consolidation therapy
- Maintenance therapy
The purpose of the first run of chemotherapy is to make the disease go away (induce a remission). This goal is achieved when the blood counts are normalized and there is no evidence of leukemia in the blood or bone marrow. This phase of treatment may last from one to three months. About 80 to 85% of patients achieve a complete response with aggressive chemotherapy. however, the disease will come back shortly after if no further chemotherapy is used. Some leukemia cells may be left behind but they cannot be detected or seen under microscope.
The most common chemotherapy regimen to induce remission uses a combination of Daunorubicin and Ara-C, in which Ara-C is given as a continuous infusion for 7 days and Daunorubicin is given intravenously daily for 3 days ( 7 and 3 regimen). This is an inpatient treatment and patients undergoing this treatment will spend about one month in the hospital.
This regimen is highly toxic and will cause severe anemia, low white count and low platelet count. Most patients will need blood and platelet transfusions, as well as intravenous antibiotics and intravenous nutrition. To facilitate the treatments, every patient should have a Central Venous Access Line (or a similar device) prior to initiation of chemotherapy or very soon after. Other potential complications of AML and its treatment are:
- High calcium levels
- High uric acid levels
- Tumor Lysis syndrome
Use of intensive and aggressive chemotherapy after induction of remission reduces the rate of recurrence of AML. This portion of treatment may last a few months. Bone marrow transplantation, when a donor is available, is the best form of consolidation treatment for AML.
The most common consolidation chemotherapy regimen uses a combination of high doses of Ara-C, in which Ara-C is given as an intravenous injections twice daily for 5-7 days, along with some other drugs. These are all inpatient treatments and patients undergoing this treatment will spend about one month or more in the hospital.
Consolidation regimens are highly toxic and will cause severe anemia, low white count and low platelet count. Most patients will need blood and platelet transfusions, as well as intravenous antibiotics and intravenous nutrition. To facilitate the treatment, every patient should have a Central Venous Access Line (or a similar device) prior to initiation of chemotherapy, or very soon after.
Different institutions may use different protocols for each phase of the treatment. The following is a list of the most common drugs used in different stages.
Daunorubicin, Adriamycin, Ara-C, VP-16, Teniposide, Mitoxantrone, Idarubicin, Carboplatin and Myelotarg.
There seems to be a benefit for maintenance chemotherapy after the consolidation treatment and this issue remains to be better defined
Acute Promyelocytic Leukemia is a variant of AML (M3) associated with a severe coagulation complication. This variant has a better prognosis and responds well to Retinoic Acid and Arsenic Trioxide.The treatments for this type of leukemia can be different and best undertaken in hands of experienced hematologist/oncologists.
Following is a partial list of indications for Bone Marrow Transplantation in AML:
- Patients who have an identical twin
- Patients who have a well matched sibling
- Patients under age 65
