Acute myeloid leukemia is usually described as:
Untreated. Untreated AML is newly diagnosed.
In remission. AML that is in remission has been treated. The patient does not currently have any signs or symptoms of leukemia.
Recurrent (relapsed). Recurrent AML has been treated. It has come back after going into remission.
Refractory AML is leukemia that has not responded to the initial treatment.
A care team will recommend treatment based on several factors, including:
Age of the patient.
The subtype of AML.
Whether the cancer has spread to the central nervous system (brain and spinal cord).
Whether the patient has been treated in the past for another cancer.
Whether the person has had a blood disorder such as myelodysplastic syndromes.
Whether the AML has been treated before and come back.
When you are considering a treatment option, it's important to ask your doctor about the expected benefits and risks of a particular therapy.
There are usually two phases of treatment. The first phase aims to put the leukemia into remission. The second phase is intended to prevent a relapse.
In the first treatment phase, doctors kill as many leukemia cells in the blood and bone marrow as possible. When this phase is successful, the disease is considered to be in remission.
Standard treatment for AML involves chemotherapy to stop the growth of cancer cells. Chemotherapy for AML is usually given as combination chemotherapy. This means that more than one anticancer drug is used.
Chemotherapy can be taken by mouth or injected into a vein or muscle. It enters the bloodstream and travels throughout the body. Chemotherapy may also be injected directly into the fluid surrounding the brain and spinal cord. This may be done to treat adult AML that has or may spread to the central nervous system.
Chemotherapy treatments usually cause side effects. Your doctor can suggest ways to manage these side effects. Side effects may include:
Increased risk of infection
In the second treatment phase, steps are taken to kill any remaining leukemia cells that could cause a relapse. The second phase of treatment may involve:
Chemotherapy with or without radiation therapy and a stem cell transplant
Radiation therapy uses high-energy radiation to kill cancer cells or stop them from growing. It can also help reduce pain in bone that has been affected by leukemia.
A more recent treatment for AML is a stem cell transplant. A stem cell transplant replaces a person's blood-forming cells. Stem cell transplants can use stem cells from your own body or from a donor. Donor stem cell transplant may be necessary if the patient's own stem cells are abnormal or have been destroyed by cancer treatment.
Stem cells (immature blood cells) are removed from the blood or bone marrow of a patient or donor. Once removed, they are examined under a microscope and the cell number is counted. The stem cells are stored for future use.
The patient then undergoes high-dose chemotherapy to eradicate the leukemic cells that populate the bone marrow. The stored stem cells are then infused into the patient's bloodstream. They migrate into the bone marrow space. Because these are stem cells, they are able to regenerate and grow into the many different cells that normally populate the bone marrow.
Stem cell transplants require very high dose chemotherapy to rid the body of all the leukemia. In the process, the patient cannot make any blood cells until the stem cells have had time to mature. This puts the patient at high risk of infection and bleeding. In addition to the short term risks, there are also long term side effects. Stem cell transplants should be undertaken only in specialized centers.
Treatment for recurrent AML in adults depends on the subtype. It may include chemotherapy, cell transplant, or other types of treatment.
Patients should continue to have regular follow-up exams and tests, even if they are in remission.