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Types of treatment for acute myeloid leukaemia

Men and women discussing acute myeloid leukaemia

This page gives you an overview of the treatments used for acute myeloid leukaemia (AML). You can find the following information

 

A quick guide to what's on this page

Types of treatment for acute myeloid leukaemia

The main treatment for AML is chemotherapy. Other treatments for AML include growth factors, radiotherapy, and bone marrow transplants or stem cell transplants. The treatment for acute myeloid leukaemia varies depending on your type of AML, your general health, and your age and level of fitness.

The phases of treatment for AML

Acute myeloid leukaemia treatment has 2 main phases. The first phase is called induction. The aim is to get rid of all signs of the leukaemia. The first treatment you have is chemotherapy. If all signs of the leukaemia disappear, you are said to be in remission.

Then you have consolidation treatment to lower the risk of your leukaemia coming back. This may be more chemotherapy, or a transplant of bone marrow or stem cells from a donor. Rarely, you may have a transplant with your own blood stem cells. Bone marrow and stem cell transplants are known as intensive treatment.

Treating AML that comes back or resists treatment

Sometimes leukaemia cells are left in the bone marrow after your treatment. This is called resistant leukaemia. You may have more chemotherapy, or your doctor may suggest a stem cell transplant as part of a clinical trial. If the leukaemia comes back after a period of remission it is called a relapse. Again, you may have more chemotherapy or a stem cell transplant.

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating AML section.

 

 

The main treatments for AML

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

If you have a very high white blood cell count when you are diagnosed you may have a procedure called leukapheresis. Leukapheresis removes the abnormal white blood cells from the blood. This procedure is not used for people with type M3 AML (acute promyelocytic leukaemia) as it can cause bleeding in this type of AML. There is information about leukapheresis in the question and answer section.

On other pages in this section there is information about the following treatments for AML

Further down this page is information about when you may have a particular type of treatment and why.

 

Deciding on your treatment options

The treatment for acute myeloid leukaemia varies depending on

  • Your type of AML
  • Your general health
  • Your age and level of fitness
  • Whether you have particular gene changes (mutations) in the leukaemia cells

Different types of AML are treated differently. 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 that you join a trial. Our research section has information about understanding clinical trials, including what it is like to take part.

You can find details of individual trials for acute leukaemia on our clinical trials database.

 

Treatment phases for AML

Acute myeloid leukaemia treatment has 2 main phases

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 lower the chance of your leukaemia coming back. Doctors call this consolidation treatment or maintenance treatment.

 

Getting rid of the AML (induction)

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 transfusions 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, between 5 and 7 out of 10 people with adult acute myeloid leukaemia (50% to 70%) 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, which is called consolidation therapy.

 

Stopping AML coming back (consolidation)

Once there is no sign of the leukaemia, you have consolidation treatment to stop it coming back again. 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.

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 chemotherapy 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.

 

AML that comes back or resists treatment

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.

 

The treatment team

Everyone with acute myeloid leukaemia should be under the care of a multidisciplinary team (MDT). This is a team of health professionals who work together to decide on the best way forward for each patient. 

The MDT includes the following people

  • Blood cancer specialists called consultant haematologists
  • Haematology nurse specialist
  • Dieticians
  • Doctors specialising in diagnosing blood illnesses, called haematopathologists
  • Doctors specialising in diagnosing and controlling infection called microbiologists
  • Symptom control specialists called palliative care doctors and nurses
  • Pharmacists specialising in cancer drugs
  • Social workers
  • Psychologists
  • Doctor specialising in cancer drug treatment called a medical oncologist
  • Doctor specialising in radiotherapy treatment called a clinical oncologist
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Updated: 11 February 2014