Types of treatment for acute myeloid leukaemia

Most people with acute myeloid leukaemia start treatment quickly after diagnosis. The main treatment is chemotherapy. Other treatments you might need include blood and platelet transfusions and antibiotics.

Treatments for AML include

• Chemotherapy
• Growth factors
• Radiotherapy
• Bone marrow or stem cell transplant

These links take you to pages specifically about these treatments for AML. Below, on this page, is information about when you may have a particular type of treatment and why.

The treatment for acute myeloid leukaemia varies depending on

• Your type of AML
• Your general health
• Your age and level of fitness

Different types of AML are treated differently. There is information about this in each treatment section. Your doctor will be able to explain the treatments that are suitable in your case.

Researchers and doctors continue to look for better combinations of treatments, as well as new treatments. They test these in clinical trials. Your doctor may suggest you join a trial. CancerHelp UK's research section has information about understanding clinical trials, including what it is like to take part.

You can find details of individual trials in the CancerHelp UK clinical trials database. Choose 'leukaemia: acute leukaemia' from the drop down menu of cancer types.

Acute myeloid leukaemia treatment has two main phases

• Getting rid of the AML (induction)
• Treatment to stop AML coming back

The aim of induction is to get rid of the leukaemia. The first treatment you have is chemotherapy. This aims to get rid of all signs of the leukaemia. If it works, you are said to be ‘in remission’.

Then you have treatment to stop your leukaemia coming back. Doctors call this consolidation treatment.

The aim of this phase of treatment is to destroy the leukaemia cells. It is called ‘remission induction’. In remission there is no sign of the leukaemia in your blood or bone marrow. You may need to stay in hospital for about a month.

Before you start chemotherapy you may need to have blood and platelet transfusions. Then you have treatment with chemotherapy. You have a number of chemotherapy drugs over a few days.

The chemotherapy drugs kill off many of your normal bone marrow cells as well as the leukaemia cells. If the treatment works, normal bone marrow cells come back in 2 to 3 weeks and start making blood cells again. Overall, about 7 out of 10 people (70%) with adult acute myeloid leukaemia go into remission with induction chemotherapy.

If you are not in remission after this treatment, you will need to have more remission induction chemotherapy. You may have a different combination of drugs from the first time round.

Even if you are in remission after the treatment, a very small number of leukaemia cells may survive. Although there may be too few to see in blood or bone marrow tests, the leukaemia is likely to come back without further treatment. To try to stop this, you have the next stage of treatment - called consolidation therapy.

Once there is no sign of the leukaemia, you will need treatment to stop it coming back again. Doctors call this ‘consolidation treatment’. It may mean

• More chemotherapy
• A donor transplant
• A transplant with your own blood stem cells (this is rarely used for AML)

Bone marrow and stem cell transplants from a donor or with your own cells are known as intensive treatment. There is information about this type of treatment in this section of CancerHelp UK.

Doctors take into account many factors when deciding which consolidation therapy to recommend for you. These include

• Whether your leukaemia is completely in remission
• Whether you have leukaemia after past treatment for another cancer
• Whether you had a chronic leukaemia that has changed (transformed) into the acute type
• How many times you had chemotherapy before your leukaemia went into remission
• Your general level of fitness and health

Your doctor will also take into account your own wishes and feelings about treatment.

If you had more than one induction chemo course to get you into remission, your doctor may suggest a donor transplant, if a donor is available. If there is no suitable donor, your doctor may suggest that you have a stem cell transplant using your own blood stem cells.

A lot of research is looking into the role of transplants in treating adult acute leukaemia. The research aims to make these treatments safer and more successful. This is very intensive treatment. You need to understand all the risks before you and your doctor decide what to do. Unfortunately, sometimes people die because of the treatment, rather than from the leukaemia itself. People take this risk because transplant gives them the best chance of long term remission or even cure.

Transplants can have long term effects that lower your quality of life after you finish the treatment. You need to fully understand this too before you agree to any treatment. You will need to discuss all these pros and cons with your specialist before making a decision.

Sometimes tests find leukaemia cells in the bone marrow after you have had treatment. This is called resistant leukaemia. You may have more chemotherapy, using different drugs from the first time. Or your doctor may suggest a stem cell transplant as part of a clinical trial.

If you go into remission, the leukaemia sometimes comes back later on. This is called a relapse. Treatment for relapsed leukaemia depends on

• How long you were in remission
• Your age and general level of fitness and health
• Certain features of the leukaemia cells

You may have the same drugs you had when you first went into remission. Or you may have a different combination of chemotherapy drugs or a stem cell transplant. Your doctor will discuss all your treatment options with you.