AML treatment should be done at experienced cancer centers. Treating cancer takes a team of doctors, health care workers, and social care professionals from different professional backgrounds who have knowledge and experience with acute leukemia.
There are 3 phases of treatment: induction, consolidation, and maintenance.
Induction is the first phase of treatment. The goal of induction is remission. This initial treatment is called remission induction therapy. After induction, you will have bone marrow tests to look for a response (remission).
Most commonly used chemotherapy regimen is 7+3 treatment (7 days of cytarabine and 3 days of idarubicin, daunorubicin or doxorubicin).
For older patients, hypometilating agents (azacytidine or decitabine) alone or combination with venotoclax are often used.
Targeted treatment can be added these regimens. For flt3 positive patients Midostaurin, for CD 33 positive good risk patients gemtuzumab can be added.
When there are no signs of cancer and blood counts have recovered, it is called a complete response or complete remission.
In complete remission:
- There is no sign of leukemia after treatment
- Your blood counts have returned to normal
- You have less than 5 percent (5%) blasts in your bone marrow (or less than 5 blasts out of every 100 blood cells)
- This does not mean that AML has been cured. Remission can be short-term or long-lasting.
Consolidation treatment is given after induction, for those in remission. It is needed to kill any cancer cells that might be left in the body after induction. This is to prevent cancer from returning. Standard types of consolidation include a stem cell transplant or more chemotherapy. Sometimes, this treatment is called post-remission therapy, which might be a combination of consolidation and maintenance therapy. Cosolidation treatment usually done with high dose cytarabine.
For older patients, hypometilating agents (azacytidine or decitabine) alone or a combination with venotoclax can be given. After first consolidation treatment, patients with intermediate and high risks undergo allogeneic hematopoietic stem cell transplantation.
Low risk patients with AML usually receive 3 or 4 cycles of consolidation treatment.
Maintenance can be the third phase of treatment. It is the treatment to prevent cancer from returning. Not everyone would receive maintenance therapy. Maintenance may be recommended depending on your type of disease, consolidation, and risk of relapse.
When leukemia returns after a period of remission, it is called a relapse. The goal of treatment is to achieve remission again.
Steam cell transplant (Bone marrow transplant)
A stem cell transplant (SCT) replaces bone marrow stem cells. You might hear it called a hematopoietic cell transplant (HCT) or a bone marrow transplant (BMT).
There are 2 types of BMT:
- Autologous – stem cells come from you
- Allogeneic – stem cells come from a donor who may or may not be related to you
An autologous transplant is also called HDT/ ASCR (high-dose therapy with autologous stem cell rescue). An HDT/ASCR is not used very often in AML.
An allogeneic transplant uses healthy stem cells from a donor. The donor may or may not be related to you. A donor transplant is not used for induction, the first treatment given to treat leukemia. The timing for a search to find a donor depend on your risk group. Risk group is based on the type of AML and which genetic mutations are present. After first consolidation treatment, patients with intermediate and high risks usually undergo allogeneic hematopoietic stem cell transplantation.