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Treatments for acute myelogenous leukemia
If you have acute myelogenous leukemia (AML), your healthcare team will create a treatment plan just for you. It will be based on your needs and may include a combination of different treatments. When deciding which treatments to offer for AML, your healthcare team will consider:
- your age
- the subtype of AML
- chromosome changes, or abnormalities
- whether you have had chemotherapy in the past to treat a different cancer
- whether you have had a blood disorder such as a myelodysplastic syndrome (MDS)
- whether the cancer has spread to the brain and spinal cord (called the central nervous system, or CNS)
- your overall health
You may be offered the following treatments for AML. Treatment is usually given in 2 phases, called induction and consolidation. One type of AML is treated with a third phase, called the maintenance phase.
The main treatment for AML is chemotherapy. It is used in the induction phase and the consolidation phase. It is also given in the maintenance phase, if it is used.
For other types of leukemia, central nervous system (CNS) prophylaxis is an important part of treatment. CNS prophylaxis is treatment to make sure the leukemia does not spread to or stay in the fluid in and around the brain or spinal cord (called cerebrospinal fluid, or CSF). CNS prophylaxis is not given for AML because it spreads to the CNS in only 5% of people. If AML does spread to the CNS, it is treated with chemotherapy given directly into the CSF (called intrathecal chemotherapy) and with systemic chemotherapy. The chemotherapy given directly into the CSF is given during a lumbar puncture or through an Ommaya reservoir.
Targeted therapy is sometimes used to treat AML with certain genetic mutations or AML that expresses certain proteins. Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer and limit harm to normal cells.
Stem cell transplant
Doctors may consider giving a stem cell transplant to people with AML during a first complete remission or after an early first relapse and a second complete remission.
Stem cell transplant and the chemotherapy drugs used in preparation for a stem cell transplant can cause serious side effects, so not everyone can have this treatment. A reduced-intensity transplant may be an option for some people.
Donor lymphocyte infusion
Before a stem cell transplant, blood cells are removed from the donor’s blood. If a relapse occurs after a stem cell transplant, the lymphocytes are given to the person through one or more infusions. This is called a donor lymphocyte infusion (DLI).
Radiation therapy may be used to treat AML. It may be given to:
- the whole body (called total body irradiation) to prepare for a stem cell transplant
- treat a buildup of leukemia cells, or blasts, outside the bone marrow
- relieve pain if the leukemia has spread to an area of bone
- treat AML that has spread to the central nervous system (CNS)
Supportive therapy is given to treat the complications that usually happen with treatments for AML and the disease itself. Supportive therapy can include:
- antibiotics, antivirals or antifungals to prevent or fight infections
- transfusions of blood products to replace blood cells when counts are low
- growth factors, such as filgrastim (Neupogen), to stimulate the body to make white blood cells
- drugs to bring down high levels of some chemicals in the blood that increase when many cancer cells die at the beginning of treatment (called tumour lysis syndrome)
- leukapheresis to remove large numbers of white blood cells from the blood
Response to treatment
How well leukemia responds to treatment is an important factor. It helps doctors determine prognostic risk group and plan future care. The goal of treatment is to reach a complete remission.
Complete remission, or complete response, means that the numbers of blood cells (red blood cells, white blood cells and platelets) have returned to normal levels and less than 5% of cells in the bone marrow are immature blood cells (called blast cells, or blasts). There are no general signs or symptoms of AML and no signs or symptoms that AML has spread to the brain and spinal cord (called the central nervous system, or CNS) or anywhere else in the body.
Minimal residual disease (MRD) means that there are blast cells in the bone marrow, but they can only be seen using very sensitive tests, such as flow cytometry or polymerase chain reaction (PCR). The blast cells can’t be seen with standard tests, such as looking at the cells under a microscope.
Active disease means that there are blast cells still present during treatment or the disease comes back (relapses) after treatment. Active disease means that more than 5% of cells in the bone marrow are blast cells.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits after treatment has finished, as often as every few months for several years, even if there are no signs of the disease. The time between exams will become longer as time goes on, but you will need to have follow-up exams for a long period of time. These visits allow your healthcare team to monitor your progress and recovery from treatment.
Some clinical trials in Canada are open to people with AML. Clinical trials look at new and better ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
A procedure in which a needle is inserted into the lower part (lumbar region) of the spinal column.
Doctors may use lumbar puncture to give drugs or to remove cerebrospinal fluid (CSF) for examination under a microscope or to lower spinal fluid pressure.
Also called spinal tap.
A device surgically implanted beneath the scalp that is used to deliver chemotherapy drugs directly into the cerebrospinal fluid (CSF) around the brain and spinal cord.
A substance that regulates the growth, division and survival of cells.
Growth factors are found naturally in the body. They can also be made in a lab.
Growth factors are used in biological therapy.
A procedure that uses a special machine (pheresis machine) to separate and collect specific white blood cells from withdrawn blood. The remaining blood is then returned to the body.
Leukapheresis is used to lower a very high white blood cell count in people with cancer (leukemia) or to remove white blood cells for transfusion.