Acute myeloid leukaemia - Treatment 

Treating acute myeloid leukaemia 

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Media last reviewed: 19/07/2014

Next review due: 19/07/2016

Your care team

A treatment team for AML may include:

  • a haemato-oncologist (specialist in the non-surgical treatment of leukaemia)
  • a haemato-pathologist (specialist in the study of cancerous blood cells)
  • a paediatrician (specialist in treating children)
  • a pharmacist
  • a social worker
  • a psychologist
  • a specialist cancer nurse (who will serve as the first point of contact between yourself and members of the care team)
  • a counsellor

Acute myeloid leukaemia (AML) is an aggressive condition that develops rapidly, so treatment will usually begin a few days after a diagnosis has been confirmed.

As AML is a complex condition, it is usually treated by a multidisciplinary team (MDT)  a group of different specialists working together.

Your treatment plan

Treatment for AML is often carried out in two stages:

  • Induction – the aim of this initial stage of treatment is to kill as many leukaemia cells in your bone marrow and blood as possible, restore your blood to proper working order and treat any symptoms you may have.
  • Consolidation – this stage aims to prevent the cancer returning (relapsing), by killing any remaining leukaemia cells that may be present in your body.

The induction stage of treatment is not always successful and sometimes needs to be repeated before consolidation can begin.

If you have a relapse after treatment, both reinduction and consolidation may need to be carried out. This may be the same as your first treatment, but if the relapse is a number of years later, it is likely to involve different medications or a stem cell transplant (see below).

If you are thought to have a high risk of experiencing complications of AML treatment  for example, if you are over 75 years of age or have another underlying health condition  less intensive chemotherapy treatment may be carried out. This is less likely to successfully kill all of the cancerous cells in your body, but it can help control your condition. 

Induction

The initial treatment you have for AML will largely depend on whether you are fit enough to have intensive chemotherapy, or whether treatment at a lower dosage is recommended.

Intensive chemotherapy

If you can have intensive induction chemotherapy, this will usually involve being given a combination of chemotherapy medication at a high dose, to kill the cancerous cells in your bone marrow and blood.

This stage of treatment will be carried out in hospital or in a specialist centre, as you will require very close medical and nursing supervision.

You will have regular blood transfusions, as your blood is unlikely to contain enough healthy blood cells.

You will also be vulnerable to infection, so it is important you are in a clean and stable environment where your health can be carefully monitored and any infection you have can be promptly treated. You may also be prescribed antibiotics to help prevent further infection.

Depending on how well you respond to treatment, the induction phase can last from four weeks to a couple of months. You may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve.

For intensive treatment, the chemotherapy medications will be injected into a thin tube that is inserted either into a blood vessel near your heart (central line) or into your arm (a peripherally inserted central catheter or PICC).

In very rare cases, chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. This is done using a needle that is placed into your spine, in a similar way to a lumbar puncture.

Side effects of intensive chemotherapy for AML are common. They can include: 

Most side effects should resolve once treatment has finished. You should tell your care team if side effects become particularly troublesome, as there are medicines that can help you cope better with certain side effects.

Read more about the side effects of chemotherapy.

Non-intensive chemotherapy

If your doctors don’t think you are fit enough to withstand the effects of intensive chemotherapy, they may recommend having non-intensive treatment. This involves giving the same combination of medications used in intensive chemotherapy, but at lower doses.

The main aim of this treatment is to control the level of cancerous cells in your body and limit any symptoms you are experiencing, while reducing your risk of experiencing significant side effects of treatment.

The medications used during non-intensive chemotherapy may be given through a drip into a vein, by mouth or by injection under the skin, and can often be given on an outpatient basis.

All Trans-Retinoic Acid (ATRA)

If you have the sub-type of acute myeloid leukaemia known as acute promyelocytic leukaemia, you will usually be given capsules of a medicine called ATRA, in addition to chemotherapy.

ATRA works by changing the immature white blood cells (blast cells) into mature healthy cells, and can reduce symptoms very quickly.

Side effects of ATRA can include headaches, nausea, bone pain, and dry mouth, skin and eyes.

Consolidation

If induction is successful, the next stage of treatment will be consolidation.

This often involves receiving regular injections of chemotherapy medication that are usually given on an outpatient basis, which means that you will not have to stay in hospital overnight. However, you may require some short stays in hospital if your symptoms suddenly get worse or if you develop an infection.

The consolidation phase of treatment lasts several months.

Other treatments

There are many other treatments that are used, which are described below. 

Radiotherapy

Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are two main reasons why radiotherapy is usually used to treat AML:

  • to prepare the body for a bone marrow or stem cell transplant (see below)
  • to treat advanced cases that have spread to the nervous system and/or brain, although this is uncommon

Side effects of both types of radiotherapy can include hair loss, nausea and fatigue. The side effects should pass once your course of radiotherapy has been completed.

Read more about the side effects of radiotherapy.

Bone marrow and stem cell transplants

If chemotherapy is not effective, a possible alternative treatment option is a bone marrow or stem cell transplant.

Before transplantation can take place, the person receiving the transplant will need to have intensive high-dose chemotherapy and radiotherapy to destroy the cells in their bone marrow. The donated stem cells are then given through a tube into a blood vessel, in a similar way to chemotherapy medication.

This process can put an enormous amount of strain on the body and cause significant side effects and potential complications, so you will usually need to stay in hospital for a few weeks.

Transplantations have better outcomes if the donor has the same tissue type as the person who is receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type.

Because of this, transplantations are most successful when they are carried out in children and young people, or older people who are in otherwise good health, and when there is a suitable donor, such as a brother or sister.

Read about bone marrow donation.

Clinical trials and newer unlicensed treatments

In the UK, a number of clinical trials are currently underway that aim to find the best way of treating AML. Clinical trials are studies that use new and experimental techniques to see how well they work in treating, and possibly curing, acute leukaemia.

As part of your treatment, your care team may suggest taking part in a clinical trial to help researchers learn more about the best way to treat your AML, and AML in general. Search for clinical trials for AML.

If you take part in a clinical trial, you may be offered a drug that is not licensed for use in the UK and is not normally available. However, there is no guarantee that the techniques being studied in the clinical trial will be more effective than current treatments.

Your care team can tell you whether there are any clinical trials available in your area, and can explain the benefits and risks involved.

Macmillan has information about unlicensed treatments for AML.

Page last reviewed: 23/05/2014

Next review due: 23/05/2016

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Comments

The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Grace53 said on 05 August 2014

GRD, I’m so sorry to hear about your sister. I had acute myeloid leukaemia in the late eighties at 23 years old, so I can only tell you of what I know from my own experience. I had a very straight talking haematologist who told me that prognosis worsens the older a patient is, however that’s not to say that applies in every case, and treatment has improved greatly since the 80s. You could ask your sister’s hospital for the blood test to see if you are a match for a bone marrow or stem cell transplant. My sister was tested, and wasn’t a match for me, so I had an Autograft Transplant. An Autograft Transplant is where the bad cells are destroyed by chemotherapy, then after allowing the remaining cells to recover from the chemotherapy (this can take some weeks) healthy marrow is removed from the patient and stored. Then after all the planned courses of chemotherapy have finished, the patient is given radiotherapy. Following that, the stored marrow from the patient is transplanted back to the patient. I was told this can only by carried out when the patient goes into remission after the first course of chemotherapy. I had 5 courses of chemotherapy over a period seven months, followed by the above. The other option is to contact the UK’s blood cancer charity and bone marrow register. They may be able to find a donor. Your GP will be able to advise you more about this. Good luck to you both.

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Grace53 said on 05 August 2014

GRD, I’m so sorry to hear about your sister. I had acute myeloid leukaemia in the late eighties at 23 years old, so I can only tell you of what I know from my own experience. I had a very straight talking haematologist who told me that prognosis worsens the older a patient is, however that’s not to say that applies in every case, and treatment has improved greatly since the 80s. You could ask your sister’s hospital for the blood test to see if you are a match for a bone marrow or stem cell transplant. My sister was tested, and wasn’t a match for me, so I had an Autograft Transplant. An Autograft Transplant is where the bad cells are destroyed by chemotherapy, then after allowing the remaining cells to recover from the chemotherapy (this can take some weeks) marrow is removed from the patient and stored. Then after all the planned courses of chemotherapy have finished, the patient is given radiotherapy. Following that, the stored healthy marrow from the patient is transplanted back to the patient. I was told this can only by carried out when the patient goes into remission after the first course of chemotherapy. I had 5 courses of chemotherapy over a period seven months, followed by the above. The other option is to contact Anthony Nolan, the UK’s blood cancer charity and bone marrow register. They may be able to find a donor. (www.anthonynolan.org) Good luck to you both.

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GRD said on 07 July 2014

I am a 69 year old male, i have a sister who is 83 years old.who has lukemia.

Would I be able to donate bone marrow/stemcells? or would age be against us?

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Haematologist said on 01 August 2011

Use of dasatinib is incredibly rare - doesnt deserve the amount of space given to it here

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