Typical Treatment of Acute Myeloid Leukemia
- 3 years ago
Typical Treatment of Acute Myeloid Leukemia (Except APL)
Treatment of most patients with acute myeloid leukemia (AML) is typically divided into 2 chemotherapy (chemo) phases:
Remission induction (often just called induction)
Consolidation (post-remission therapy)
The acute promyelocytic leukemia (APL) subtype of AML is treated differently.
Treatment for AML usually needs to start as quickly as possible after it is diagnosed because it can progress very quickly. Sometimes another type of treatment needs to be started even before the chemo has had a chance to work.
Treating leukostasis
Some people with AML have very high numbers of leukemia cells in their blood when they are first diagnosed, which can cause problems with normal blood circulation. This is called leukostasis. Chemo can take a few days to lower the number of leukemia cells in the blood. In the meantime, leukapheresis (sometimes just called pheresis) might be used before chemo.
In leukapheresis, the patient’s blood is passed through a special machine that removes white blood cells (including leukemia cells) and returns the rest of the blood to the patient. Two intravenous (IV) lines are required – the blood is removed through one IV, goes through the machine, and then is returned to the patient through the other IV. Sometimes, a single large catheter is placed in a vein in the neck or under the collar bone for the pheresis, instead of using IV lines in both arms. This type of catheter is called a central venous catheter (CVC) or central line and has both IVs built in.
This treatment lowers blood counts right away. The effect is only for a short time, but it may help until the chemo has a chance to work.
Induction
This first phase of treatment is aimed at quickly getting rid of as many leukemia cells as possible. How intense the treatment is can depend on a person’s age and health. Doctors often give the most intensive chemo to people under the age of 60, but some older patients in good health may benefit from similar or slightly less intensive treatment.
People who are much older or are in poor health might not do well with intensive chemo. Treatment for these patients is discussed below.
Age, health, and other factors clearly need to be taken into account when considering treatment options. For example, people whose leukemia cells have certain gene or chromosome changes are more likely to benefit from certain types of treatment.
In younger patients, such as those under 60, induction often involves treatment with 2 chemo drugs:
Cytarabine (ara-C)
An anthracycline drug such as daunorubicin (daunomycin) or idarubicin
This is sometimes called a 7 + 3 regimen, because it consists of getting cytarabine continuously for 7 days, along with short infusions of an anthracycline on each of the first 3 days.
In some situations, a third drug might be added as well to try to improve the chances of remission
Treatment of most patients with acute myeloid leukemia (AML) is typically divided into 2 chemotherapy (chemo) phases:
Remission induction (often just called induction)
Consolidation (post-remission therapy)
The acute promyelocytic leukemia (APL) subtype of AML is treated differently.
Treatment for AML usually needs to start as quickly as possible after it is diagnosed because it can progress very quickly. Sometimes another type of treatment needs to be started even before the chemo has had a chance to work.
Treating leukostasis
Some people with AML have very high numbers of leukemia cells in their blood when they are first diagnosed, which can cause problems with normal blood circulation. This is called leukostasis. Chemo can take a few days to lower the number of leukemia cells in the blood. In the meantime, leukapheresis (sometimes just called pheresis) might be used before chemo.
In leukapheresis, the patient’s blood is passed through a special machine that removes white blood cells (including leukemia cells) and returns the rest of the blood to the patient. Two intravenous (IV) lines are required – the blood is removed through one IV, goes through the machine, and then is returned to the patient through the other IV. Sometimes, a single large catheter is placed in a vein in the neck or under the collar bone for the pheresis, instead of using IV lines in both arms. This type of catheter is called a central venous catheter (CVC) or central line and has both IVs built in.
This treatment lowers blood counts right away. The effect is only for a short time, but it may help until the chemo has a chance to work.
Induction
This first phase of treatment is aimed at quickly getting rid of as many leukemia cells as possible. How intense the treatment is can depend on a person’s age and health. Doctors often give the most intensive chemo to people under the age of 60, but some older patients in good health may benefit from similar or slightly less intensive treatment.
People who are much older or are in poor health might not do well with intensive chemo. Treatment for these patients is discussed below.
Age, health, and other factors clearly need to be taken into account when considering treatment options. For example, people whose leukemia cells have certain gene or chromosome changes are more likely to benefit from certain types of treatment.
In younger patients, such as those under 60, induction often involves treatment with 2 chemo drugs:
Cytarabine (ara-C)
An anthracycline drug such as daunorubicin (daunomycin) or idarubicin
This is sometimes called a 7 + 3 regimen, because it consists of getting cytarabine continuously for 7 days, along with short infusions of an anthracycline on each of the first 3 days.
In some situations, a third drug might be added as well to try to improve the chances of remission