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Acute myeloid leukaemia (AML) treatment

We're here for you if you want to talk

0808 2080 888

[email protected]

Acute myeloid leukaemia (AML) treatment phases

The most important decision about your treatment is whether you have intensive treatment or non-intensive treatment.

Intensive treatment involves strong chemotherapy drugs (which kill leukaemia cells), sometimes given with targeted therapy drugs (which interfere with the way leukaemia cells grow). The aim of intensive treatment is to cure AML. This approach is split into two parts called remission induction therapy and consolidation therapy.

Non-intensive treatment usually involves gentler chemotherapy. The aim of non-intensive treatment is not to cure the patient but to give them the best quality of life for as long as possible.

In this section we talk about the specific treatments used for AML. You might want to read our general information about how blood cancer treatment is planned and managing your treatment.

We also have some important information on staying safe if you’ve got blood cancer, covering things like risk of infection and vaccinations.

Treatment during the coronavirus pandemic

While the coronavirus pandemic continues, your healthcare team will do their best to protect you. This might mean changes to how you're treated or where you're treated. Speak to your healthcare team if you have any questions about your treatment options.

Read our information about coronavirus and your blood cancer treatment.

Intensive treatment

Although each patient is treated on an individual basis, intensive chemotherapy is normally appropriate if you’re under 75 years of age and you have good medical fitness.

You’ll have intensive treatment in two phases called remission induction therapy and consolidation therapy. This treatment involves strong chemotherapy, sometimes with targeted therapy drugs. The treatment often successfully kills the leukaemia cells, but it’s associated with more severe side effects.

You’ll usually have three to four courses (sometimes called blocks or cycles) of treatment over four to six months. Each course lasts a few days, and you’ll normally recover from each course in about three to six weeks.

You’ll have most of your remission induction and consolidation treatment as an inpatient in hospital, but nearly all patients will get some time at home, even if it’s just for a few days.

Most patients get to go home for a week or so in between courses, usually just after chemotherapy has finished. During this time you’ll be monitored closely a couple of times a week. If you need them, you’ll be given blood and platelet transfusions, to support your body and reduce some of your symptoms.

What does intensive treatment involve?

The remission induction phase aims to clear leukaemia cells from your blood and bone marrow and quickly get your bone marrow working normally again. This treatment involves a combination of chemotherapy drugs and sometimes targeted therapy drugs. You’ll usually have two courses of chemotherapy in this phase of your treatment. The chemotherapy will be given to you by intravenous (IV) infusion, into a large vein in your arm via a long, flexible tube. There are two types of lines that may be used for the infusion:

  • a PICC (peripherally inserted central catheter) line, which will go through a vein in your arm at the end of your elbow
  • a tunnelled central line (also known as a Hickman line), which will go through a vein under your skin on the upper part of your chest.

If you're treated during the coronavirus (COVID-19) pandemic, you may receive a less intensive combination of chemotherapy and targeted therapy drugs for this phase of treatment.

Having this less intensive treatment means you won't need to stay in hospital for as long and it also reduces the risk of neutropenia - a possible side effect of stronger treatments. Speak to your healthcare team if you have any questions about your treatment options.

This interim treatment option is recommended by NICE, whose guidance is for healthcare in England, but may be (and often is) adopted in other countries of the UK too.

After you’ve finished remission induction therapy, you’ll start on consolidation therapy. The aim of this phase of treatment is to reduce your risk of relapse. Without consolidation therapy, there’s a higher risk of relapse in the year after your initial treatment.

During consolidation therapy, you’ll have more chemotherapy – usually one or two courses. You may also continue to have targeted therapy.

Some patients will also have a stem cell transplant. If you do have a transplant, you might not have any more chemotherapy after your remission induction treatment, or you just might just have one more course.

There are lots of different options for consolidation therapy, which are chosen on an individual basis. You’ll get to discuss this with your consultant.

You may also be given targeted therapy drugs as part of your induction and consolidation therapy. There are two types of targeted therapy drug offered to people with AML: gemtuzumab ozogamicin (Mylotarg®) and midostaurin (Rydapt®).

If the immunophenotyping tests you have at diagnosis detect a protein called ‘CD33’ on the surface of your leukaemia cells (most people with AML have this), your doctors may recommend that you also have gemtuzumab ozogamicin alongside chemotherapy. Gemtuzumab ozogamicin is given through an intravenous (IV) infusion on specific days of your induction therapy and consolidation therapy.

If you have a mutation called ‘FLT3’ (between 25% and 30% – just under a third – of people with AML have this) your doctors may recommend that you have midostaurin with chemotherapy. You’ll have tests to check for this mutation during the first week following your diagnosis. Midostaurin is a tablet that you take twice a day for two weeks just after each course of induction and consolidation therapy.

If you have AML caused by treatment you’ve had for another cancer or related condition, or your doctor has identified changes in your bone marrow known as myelodysplasia-related changes, you may be offered a different type of chemotherapy to the one that’s usually used for induction and consolidation therapy, called ‘liposomal chemotherapy’. It’s given in the same way as standard chemotherapy – by intravenous (IV) infusion, into a large vein in your arm.

Liposomal chemotherapy is given over three days during your first course of induction therapy. Some patients will then have a few more days of treatment during subsequent courses of induction and consolidation therapy.

Information for young adults

For young adults with leukaemia, lymphoma or any blood cancer type. Your guide to treatment, side effects, coping with emotions, friends and work or study.

Remission after intensive treatment

Your doctors will measure how well you’ve responded to treatment. During treatment you’ll have blood tests to see if your blood looks normal and if your blood cell count is normal. You’ll then have another bone marrow sample taken, to see if this looks normal too. You’ll have other genetic tests, similar to the ones you had when you were diagnosed, to look for any changes treatment has caused.

If your intensive treatment is a success, this is called remission. In remission, your bone marrow produces blood cells normally and you’ll have fewer than 5% of blast cells in your bone marrow. The DNA in your cells will also be back to normal.

If you have the FLT3 mutation, after achieving remission you’ll continue to take midostaurin on its own to help stop the cancer coming back.

Non-intensive treatment

Non-intensive treatment involves low doses of chemotherapy. Non-intensive treatment can be less effective in guaranteeing long term remission but it’s much less toxic. This may be a better option if you’re older or have other medical problems.

There are lots of different options for non-intensive treatment which vary from person to person, and no one treatment is better or worse than any other. A number of different drugs can be used and most people will be offered the chance to take part in a clinical trial.

Your treatment, and the way it’s given, will usually be tailored to your individual circumstances and aims for you to be able to spend as much quality time outside of the hospital as possible.

You’ll have most of your treatment as an outpatient, but you’ll have regular assessments with your hospital healthcare team.

Supportive care

As well as the active treatment you’ll receive to reduce the leukaemia, all patients receiving both intensive and non-intensive therapy will have a type of treatment called supportive care.

Supportive care is treatment to reduce infections, provide blood and platelet transfusions, and, in some cases, medicines to reduce bruising and bleeding.

Some people offered non-intensive treatment might decide not to go ahead with chemotherapy. This would mean you’d only receive supportive care, which will focus on helping your body to deal with the difficulties it’s having in making functioning blood cells.

Palliative care

Throughout your treatment, you might have contact with a palliative care team – they’re also known as a support care team.

They’re experts in managing your symptoms and improving your quality of life.

They’ll be able to support both you and family members. You’ll also need to take care of your general health – your palliative care team will be able to help here.

Treatment to prevent central nervous system relapse

Very rarely, patients have problems with how their nervous system is working. This happens because the leukaemia cells pass into the fluid that surrounds the brain and spinal cord (cerebrospinal fluid, or CSF). If this is the case for you, some of the symptoms you may get include loss of strength and problems with your vision or senses.

On these rare occasions, your doctors will take a sample of fluid to be tested. This is done through a procedure called a lumbar puncture. During a lumbar puncture, the doctor will take a small sample of your CSF. A very fine needle is carefully inserted between the bones of the lower spine (backbone) under local anaesthetic.

If the tests show that you have leukaemia cells in your CSF, you’ll need a series of regular lumbar punctures. The process will be very similar to the procedure for getting a sample, but instead of fluid being taken from your CSF, a chemotherapy drug will be injected into your CSF to help treat and kill the leukaemia cells. Your doctor will talk to you about this type of treatment if you need it.

Stem cell transplants

In some people, leukaemia is best cured by having a stem cell transplant. This is where a patient receives chemotherapy to reduce the leukaemia in their bone marrow, then receives blood stem cells from another healthy individual (a donor).

More information on stem cell transplants

You may be offered a stem cell transplant if you’re having intensive treatment, but only if the benefit of having a transplant outweighs the risk. This is usually based on your risk grouping.

  • In low risk patients, the benefit doesn’t normally outweigh the risk, so you won’t usually be offered a transplant. In the small number of low risk patients that do have one, or for those who relapse, the transplant will usually happen later on in your treatment schedule.
  • For intermediate risk patients the situation is more complex, and an individual decision will be made between you and your healthcare team.
  • In high risk patients, the benefit often outweighs the risk, and these patients are usually considered for a transplant early on, after consolidation chemotherapy.

For more information on stem cell transplants, order or download our booklet Blood stem cell and and bone marrow transplants: The seven steps from our publications page.

You may have the option of having a stem cell transplant as part of your relapse treatment. Patients who are under 70 in second remission (the leukaemia has gone for the second time) will be considered for a stem cell transplant, but this depends on your individual fitness and the consultant you’re seeing.

Patients over the age of around 70 may be able to have a reduced intensity transplant if they’re medically fit enough. These types of transplants have been developed to make the transplant more manageable with fewer long term side effects. If a transplant may be too risky for you, you’ll be able to discuss this with your healthcare team. It might be that you could take part in a clinical trial.

For more information on stem cell transplants, order or download our booklet Blood stem cell and and bone marrow transplants: The seven steps from our publications page.

We're here for you if you want to talk

0808 2080 888

[email protected]