What Are the Treatments for AML Subtypes?

More than 12,000 Americans are diagnosed annually with acute myeloid leukemia (AML, also known as acute myelogenous leukemia), a fast-growing cancer of the blood and bone marrow. Fortunately, since 1980, the number of patients with AML who are cured, or who enter and stay in remission for years, has increased significantly. Depending on the AML's subtype, patients have four treatment options for AML that fall into two phases.

Remission Induction Phase

• Once an AML diagnosis is made, the Remission Induction Phase begins with the goal of complete remission. To achieve this, physicians often use a combination of cytarabine and an anthracycline drug; however, these drugs carry the risk of infection and bleeding. Therefore, three to five weeks of hospitalization are needed for most patients during this phase, and two courses of therapy are sometimes needed for complete remission, which is achieved by 75 percent of younger adults, and 50 percent of those over 50.

Post-Remission Consolidation Phase

• This phase is also known as Intensification, and includes the use of different drugs to kill any AML cells that remain after a successful Remission Induction Phase. This follow-up phase is necessary because AML will usually recur if no further therapy is given after a successful remission. For some patients, stem-cell transplantation may be a substitute for this phase.

  The therapies used in both the Remission Induction and the Post-Remission Consolidation phases are chemotherapy, other drug therapy, stem cell transplant and clinical trials.

Chemotherapy

• As the primary treatment for AML, chemotherapy is administered by mouth, injected into a vein or injected into the cerebral spinal fluid. Patients with AML generally stay in the hospital during chemotherapy treatments.

Other Drug Therapy

• The anti-cancer drugs arsenic trioxide and all-trans-retinoic acid (ATRA) work alone or in combination with chemotherapy for the AML subtype, Acute Promyelocytic Leukemia (APL). Because the APL subtype is sensitive to the effects of ATRA, patients with the APL subtype often require large numbers of platelet and blood transfusions due to bleeding. The combination of ATRA and chemotherapy (with idarubicin or daunorubicin) has a very high probability of complete remission.

Stem Cell Transplant

• The goal of stem cell transplantation is twofold: destroy cancer cells in the bone marrow, blood and any other parts of the body; and have replacement blood stem cells create healthy bone marrow, which was destroyed along with the cancer cells by chemotherapy and/or radiation therapy.

Clinical Trials

• In cases where leukemia is still present after initial treatment, the disease is considered as recurrent, or refractory, and patients may then be considered for new drugs being tested in clinical trials. All patients choosing to join a clinical trial will participate in an informed consent process, during which the doctor will list all options in order to be certain the patient understands how the clinical trial's treatment will differ from the standard treatment.