How Acute Myeloid Leukemia Is Treated

Treatments for acute myeloid leukemia (AML) are better than ever. Chemotherapy is the standard treatment, and targeted drug therapy may be used along with it. Stem cell transplantation may be done, and this may involve radiation treatment in preparation for it.

One subtype of AML, acute promyelocytic leukemia, is treated with drugs that allow the immature cells to mature rather than standard chemotherapy. Here's what to know about the current approaches available and how they can help to effectively treat leukemia.

Prescriptions and Therapies

For acute myeloid leukemia, standard treatment involves chemotherapy. Bone marrow transplant, radiation therapy, as well as other therapies may also be used.

Leukapheresis

Some people are diagnosed with high numbers of leukemia cells in the blood initially, known as leukostasis. Since chemotherapy can take a few days to work, a process known as leukapheresis is sometimes used to reduce the number of leukemia cells circulating in the blood even before chemotherapy is given.

With this, a machine is used to remove the white blood cells from the body, including the leukemia cells. This goes out through one line and is filtered through the machine. It is then returned to the patient through the other IV.

This immediately lowers the blood count. It is, however, just a temporary measure to allow the chemotherapy a few days to kick in and begin working.

Chemotherapy

With chemotherapy, the idea is to use potent drugs to kill or damage cancer cells. In some cases, this is taken by mouth and in others it is injected right into the bloodstream. It can also be injected directly into the cerebrospinal fluid, in the rare instances that AML has spread to the brain or spinal cord.

There are two phases of chemotherapy for acute myeloid leukemia. These include:

• Remission induction
• Consolidation

Induction is the first phase, with the idea of quickly killing as many leukemia cells as possible. The intensity of this can be varied somewhat depending upon someone's age and health. Those under age 60 are usually eligible for the most intensive chemotherapy.

Some who are older and in reasonably good health may likewise benefit. Or, a slightly less intensive regimen may be used instead.

Typically, the regimen involves the agent cytarabine (ara-C), as well as an anthracycline such as idarubicin or daunorubicin (daunomycin). A third drug may also be added in some cases.

This may include some more targeted drugs directed at mutations in the FLT3 gene, sometimes used to treat leukemia. Some drugs that block FLT3 include Rydapt (midostaurin) and Xospata (gilteritinib). Both of these agents are taken by mouth. The chemotherapy drug cladribine is another possibility.

To see how you do with this induction treatment the doctor will wait about one week after chemotherapy and then will perform a bone marrow biopsy. Ideally, this should show only a few bone marrow cells, with blasts making up no more than 5% of the marrow.

After completing the first round of chemotherapy, most people actually do go into remission. For those who don't, the doctor may repeat the same chemotherapy regimen, or may try a new one.

Another biopsy will be done to check the bone marrow again. If it is still unclear whether all the cancer is gone, this biopsy may be repeated a week later. At this point, a stem cell transplant may be called for in some cases.

Expect another biopsy to be done once your blood cell counts begin to rebound. While the idea is to check for remission, keep in mind that this initial therapy does not usually get all the leukemia cells. Consolidation therapy is usually needed to ensure that there is no relapse.

Supportive Treatment

While chemotherapy is often effective in killing the cancer, this can also destroy normal cells and can cause side effects such as hair loss, which will grow back after completing the chemo, as well as sores in the mouth, nausea and vomiting, appetite loss, and diarrhea or constipation.

Due to lowering of blood counts, there's also greater risk of infection, bruising, and fatigue.

Some supportive measures here can include:

• Drugs to reduce nausea and vomiting.
• Careful hand washing to lower germ risk and asking others around you to do the same.
• Staying away from foods that may carry germs such as uncooked fruits and vegetables.
• Avoiding large crowds where infections may lurk.
• Taking antibiotics at earliest signs of infection.
• Getting growth factors to increase white blood cell counts and lower infection risk.
• Compensating for low platelet counts with drugs or transfusions.
• Receiving red blood cell transfusions to combat fatigue or shortness of breath.

These can hopefully make both the induction phase of chemotherapy, as well as the consolidation phase much easier to get through.

Consolidation Therapy

If remission is achieved, the induction therapy is considered successful. However, in many cases it's necessary to introduce further treatment with a second phase to kill any lingering cancer cells, with what's known as post-remission consolidation therapy.

For those younger than age 60, the options here include:

• Using high-dose cytarabine (ara-C) for several cycles
• Undergoing stem cell transplant using donor cells
• Undergoing stem cell transplant with your own cells

With this approach, ultra high doses of cytarabine are used, typically at the hospital. Expect this to be given over a five-day period and then given again after four weeks for 3 to 4 cycles. If you received the drug midostaurin (Rydapt) during induction, expect this to be part of your consolidation treatment as well.

Likewise, if your induction therapy involved gemtuzumab ozogacamin (Mylotarg), which is a targeted drug, then something similar may be given for consolidation.

In many cases, after high doses of chemotherapy are given following induction, it may become necessary to undergo a stem cell transplant, which can come from your own or from donor cells. While these are very effective in keeping the leukemia from returning, they also more likely to involve serious life-threatening complications.

Those who are older or generally in more frail health usually cannot tolerate this intensive approach. Instead, they may be given a somewhat higher-dose of cytarabine during consolidation if this is feasible.

Or, they may continue with a standard-dose of the cytarabine, together with agents such as idarubicin, mitoxantrone, or daunorubicin. Like younger people, those who received midostaurin (Rydapt), older ones are often given this again during consolidation.

Also, instead of a full stem cell transplant, a mini non-myeloablative one is typically given instead.

Radiation Therapy

Radiation is not the main treatment for AML but can be used in addition to chemotherapy in specific circumstances. This type of approach uses high-energy X-rays or other radiation to tamp down on cancer cells. This can be done in different ways such as:

• External radiation: A machine outside of the body directs radiation towards the cancer. In cases where leukemia has spread from the bone marrow and blood to an organ, this may be used.
• Total body irradiation: This involves radiation directed at the whole body. This may often be used in recurrences to prepare the body for a stem cell transplant.

Additional Drug Therapy

In some cases, prescription medication may also be used for the continued treatment of acute myeloid leukemia. Onureg (azacitidine), for instance, is an FDA-approved drug for patients with AML who achieved first complete remission with or without recovery of their blood cell counts following intensive induction chemotherapy, and who are not able to complete intensive curative therapy.

For acute promyelocytic leukemia, which is a subtype of acute myeloid leukemia, agents such as arsenic trioxide and all-trans retinoic acid are used to kill leukemia cells and keep these from dividing, or to allow them to actually mature into white blood cells.

Tibsovo (ivosidenib tablets) is a once-daily medication approved to treat IDH1-mutated AML. It can be given alone or in combination with azacitidine to treat newly diagnosed persons who are 75 years and older or who have health problems that prevent the use of intensive chemotherapy. Tibsovo can also be used to treat those whose disease has returned or failed to respond to previous treatments.

Surgeries and Specialist-Driven Procedures

One of the drawbacks of chemotherapy is that unfortunately, this can also harm otherwise healthy blood-forming cells. Since this is where new blood cells are made, this can hamper their formation.

If bone marrow is damaged, this can result in bleeding, life-threatening infections, and other issues depending on the type of cells that are low. Here's what can happen:

• Low red cells (anemia) can produce fatigue and more.
• Low white cells (neutropenia) can increase the risk of infection.
• Low platelets (thrombocytopenia) can lead to bruising and bleeding.

To treat this, stem cell transplantation can be used. With stem cell transplantation, before chemotherapy stem cells are removed from the patient's bone marrow, frozen, and stored. Or, they can be taken from a donor.

Once chemotherapy or whole-body irradiation is complete, the frozen stem cells can be thawed and reinfused into the body. These can then once again begin to produce needed blood cells.

There are two different types of stem cell transplants that can be done. In an allogeneic transplant, the marrow comes from someone else. In an autologous transplant, it is your own cells.

The allogenic is the most common type. The issue with this is there are genetically determined compounds on the surface of the cells. Your immune system can react to these in some cases. So, the closer the tissue is to your own the better. Close family members such as a brother or sister tend to make the best matches.

These allogeneic transplants are preferred for those with a high risk of experiencing a recurrence. That's because of the graft-versus-leukemia effect. This means the donor cells may sometimes attack leukemia cells after recognizing them as something foreign, something that unfortunately won't happen with your own cells.

On the flip side, when the cells come from others there can be some serious side effects. So, this means that to be good candidates, patients need to be younger and healthier.

Autologous stem cells from your own body tend to be easier to tolerate. One worry with these, however, is that it can be difficult to remove all of the leukemia cells before returning these to your system.

Home Remedies and Lifestyle

Many people with acute myeloid leukemia will examine their lifestyle and make some modifications. Here are some factors that may help to enhance your overall health:

• Getting seven to nine hours of sleep
• Maintaining good nutrition
• Manage your stress
• Exercising
• Maintaining a healthy diet
• Drinking enough fluids
• Eating enough protein
• Consuming probiotics
• Avoiding any foods that may cause food poisoning, such as hot dogs, deli meat, undercooked beef shellfish and eggs, and unpasteurized fruit juice.

Complementary and Alternative Medicine (CAM)

While traditional treatments are very effective in many cases in controlling acute myeloid leukemia, approximately 2 out of 3 cancer patients try at least 1 alternative measure to augment their care. These can often help with the following:

• Alleviating stress
• Boosting healing
• Reducing treatment side-effects like nausea.

Therapies that can often help with this include:

• Aromatherapy
• Massage
• Tai chi
• Yoga

Some people may also use foods and herbal remedies as part of their approach to treating acute myeloid leukemia. The following have shown some activity against leukemia cells in the lab or in animal models, while they have not been studied in humans with leukemia:

• Hibiscus cannabinus (Kenaf)
• Euphorbia formosana
• Allium sativum (garlic)
• Moringa oleifera
• Vermonia amygdalina
• Grape seed
• Pomegranate
• Carrots

A Word From Verywell

While dealing with acute myeloid leukemia may feel overwhelming, the good news is that there are so many useful treatment options available. We at VeryWell want patients to be sure they are availing themselves of the ones that are best for them.