A team of doctors and other professionals discuss the best treatment and care for you. They are called a multi disciplinary team (MDT).
Your MDT might include:
- blood cancer specialists called consultant haematologists
- haematology nurse specialists, also called clinical nurse specialists (CNS)
- doctors specialising in reporting bone marrow or lymph node biopsies (haemopathologists)
- doctors specialising in reporting x-rays and scans (radiologists)
- doctors specialising in diagnosing and controlling infection (microbiologists)
- social workers
- symptom control specialists called palliative care doctors and nurses
Deciding which treatment you need
Your MDT will discuss your treatment, its benefits and the possible side effects with you. Your treatment will depend on:
- the type of leukaemia you have
- your age, general health and level of fitness
- if you have gene changes (mutations) in the leukaemia cells
The main treatment for acute myeloid leukaemia (AML) is chemotherapy. Other treatments include:
- targeted cancer drugs
- growth factors
- stem cell or bone marrow transplants
If you have a very high white blood cell count when you are diagnosed, you might have leukapheresis. This removes the abnormal white blood cells from the blood. You won't have this if you have M3 AML, also called acute promyelocytic leukaemia. It can cause bleeding in this type of AML.
Supportive treatmentsYou might need other treatments to support you while you have your main leukaemia treatment. This might be because you have an infection or to help with the side effects of treatment. These include:
- anti sickness medicines
- blood transfusions
- platelet infusions
There are different phases of treatment. These are:
- getting rid of the leukaemia cells (remission induction)
- lowering the risk of it coming back (consolidation)
Some people may also have treatment to keep their AML away in the long term. This is called maintenance therapy.
Getting rid of the leukaemia cells (induction treatment)
The aim of the induction phase is to destroy the leukaemia cells. It's called remission induction. In remission there is no sign of the leukaemia in your blood or bone marrow.
The main treatment is chemotherapy. You may also have a targeted drug with your chemotherapy.
The chemotherapy drugs kill off many of your bone marrow cells as well as the leukaemia cells. So you might need to stay in hospital for about a month until you have recovered.
Lowering the risk of leukaemia coming back (consolidation treatment)
Once there is no sign of the leukaemia, it is called remission. You have consolidation treatment to lower the risk of it coming back.
Consolidation treatment might include chemotherapy or targeted drugs. You might have a stem cell transplant.
How your team plans consolidation treatment
The team looking after you will consider:
- if your leukaemia is in full remission
- if you have leukaemia after treatment for another cancer
- whether you had chronic leukaemia that has changed into acute leukaemia
- how many times you had chemotherapy before your leukaemia went into remission
- your general level of fitness and health
- your wishes about treatment
Keeping AML away long term (maintenance therapy)
Maintenance therapy helps to keep the leukaemia in remission. You might have chemotherapy or targeted drugs.
Intensive treatment and stem cell transplant
You might need more than one round of induction chemotherapy before your leukaemia goes into remission.
In this situation, your team might recommend intensive chemotherapy and a stem cell transplant using either:
- your own stem cells or bone marrow (autologous transplant), or
- a donor's stem cells or bone marrow (allogeneic transplant)
Having a stem cell transplant is a very intensive treatment. Sometimes people die because of the treatment rather than from their cancer. People take this risk because transplant gives them the best chance of long term remission or cure.
You need to discuss all these pros and cons with your specialist team and the people close to you before making a decision.
Researchers are looking into the role of transplants in treating AML. The research aims to make these treatments safer and more successful.
AML that comes back or resists treatment
Sometimes tests find leukaemia cells in the bone marrow after you have had treatment. You might:
- have more chemotherapy or targeted drugs
- have a stem cell transplant as part of a clinical trial
Sometimes the leukaemia comes back. This is called a relapse. Treatment for relapsed leukaemia depends on:
- how long you were in remission
- your age and general level of fitness
- how your leukaemia cells look under the microscope
Your doctor will discuss all your treatment options with you.
Clinical trials to improve treatment
Your doctor might ask if you’d like to take part in a clinical trial.
Doctors and researchers do trials to:
make existing treatments better
develop new treatments