Acute Myeloid Leukemia Treatment: What to Expect

Understanding Acute Myeloid Leukemia (AML) Treatment: Key Insights

Leukemia is an overarching term that includes several specific types, one of which is acute myeloid leukemia (AML). According to the National Cancer Institute (NCI), more than 20,000 new AML cases were projected to be diagnosed in 2021 alone. Since treatment strategies differ based on the precise type of leukemia, obtaining an accurate diagnosis is essential. Your healthcare provider will outline available treatment plans tailored to your specific circumstances and subtype of AML. Explore the following details about various treatment options for AML.

What is Acute Myeloid Leukemia (AML)?

Acute myeloid leukemia (AML) is a cancer that originates in the blood and bone marrow, primarily affecting white blood cells (WBCs) and altering their normal function. Certain variants of AML can cause rapid WBC proliferation. Other names for AML include:

  • Acute myelocytic leukemia
  • Acute myelogenous leukemia
  • Acute granulocytic leukemia
  • Acute non-lymphocytic leukemia

A Range of Treatment Options for AML

Upon confirming a diagnosis of AML, your medical team will devise a comprehensive treatment strategy. Depending on the type and stage of AML, treatment methods may include:

Chemotherapy

Chemotherapy serves as the primary treatment for AML. It typically unfolds in two phases:

  • Remission Induction: commonly referred to as induction.
  • Consolidation Therapy: also known as post-remission therapy.

Due to the aggressive nature of AML, treatment usually begins promptly after diagnosis. Chemotherapy consists of anti-cancer medications administered either intravenously or through subcutaneous injections to circulate through the bloodstream and target cancer cells systemically. If leukemia is detected in the central nervous system, medications may be administered directly via cerebrospinal fluid (CSF).

Common Chemotherapy Drugs for AML

  • Cytarabine: Also called cytosine arabinoside or Ara-C.
  • Anthracyclines: Includes daunorubicin and idarubicin.
  • Other agents may include:
    • Cladribine (2-CdA)
    • Fludarabine
    • Etoposide (VP-16)
    • Corticosteroids
    • Methotrexate (MTX)

Possible Side Effects of Chemotherapy

Side effects can vary based on the specific medications and treatment duration. They may include:

  • Hair loss
  • Mouth sores
  • Loss of appetite
  • Nausea and vomiting
  • Diarrhea or constipation
  • Fatigue
  • Easily bruising or bleeding

Alternative Medications

While chemotherapy remains a central treatment for AML, specific subtypes—such as acute promyelocytic leukemia (APL)—may respond better to alternative medications. APL results from distinct genetic mutations that influence WBCs. Drugs that may be more effective include:

  • All-trans retinoic acid (ATRA)
  • Arsenic trioxide (ATO, Trisenox)

ATRA can be combined with ATO or chemotherapy during initial APL treatment. You may experience side effects from ATRA such as:

  • Headache
  • Fever
  • Dry skin and mouth
  • Mouth/throat sores
  • Elevated blood lipid levels
  • Eye irritation

Radiation Therapy

Although not the cornerstone of AML treatment, radiation therapy can be utilized effectively in certain circumstances. This approach employs high-energy radiation directed at cancer cells, primarily using external beam radiation akin to X-rays.

Applications for radiation in AML may include:

  • Treating leukemia that has metastasized to the brain, spinal cord, or testes.
  • Preparing the body for a stem cell transplant.
  • Shrinking tumors that impact breathing.
  • Addressing bone pain not mitigated by chemotherapy.

Side effects could comprise:

  • Low blood counts leading to fatigue or increased infection risk
  • Nausea, vomiting, or diarrhea if at the abdominal area
  • Skin changes resembling sunburn or localized hair loss
  • Mouth sores and swallowing difficulties when targeted at the head/neck

Important Questions to Discuss with Your Doctor

Before commencing AML treatment, consider discussing these crucial questions with your healthcare team:

  • What specific type of AML am I diagnosed with?
  • Will further tests be necessary prior to treatment?
  • What are my options regarding treatment?
  • What is your recommended course of treatment?
  • Should I consider a second opinion?
  • How should I prepare for treatment?
  • What are the potential risks and side effects?
  • How will we monitor the effectiveness of the treatment?
  • What are the next steps if treatment proves ineffective?
  • How will this impact my daily life?

Surgery in AML Treatment

Surgery is infrequently employed in treating AML due to the condition's systemic nature. However, in rare cases where a mass develops, surgical intervention may be necessary. Often, a preparatory surgical procedure is performed to place a central venous catheter (CVC), facilitating easier administration of intravenous treatments, minimizing the need for repeated needle punctures.

Stem Cell Therapy

Due to the toxicity associated with high-dose chemotherapy, and its limitations, a stem cell transplant can enhance treatment options. This procedure entails administering very high doses of chemotherapy—sometimes alongside radiation—to destroy the original bone marrow. Subsequently, blood-forming stem cells are reintroduced to foster healthy bone marrow regeneration.

Targeted Therapy

Targeted therapies are innovative medications designed to attack specific components of cancer cells. These can be particularly beneficial for certain AML patients, primarily administered orally, though some require intravenous infusion. Key targeted therapies include:

FLT3 Inhibitors

FLT3 inhibitors target the FLT3 gene mutations, which can accelerate cancer cell growth in some AML patients. Examples include:

  • Midostaurin (Rydapt)
  • Gilteritinib (Xospata)

IDH Inhibitors

Medications like ivosidenib (Tibsovo) and enasidenib (Idhiva), block the action of mutated IDH enzymes that hinder normal blood cell maturation.

Monoclonal Antibodies for CD33

Gemtuizumab ozogamicin (Mylotarg) attaches to the CD33 protein found in AML cells to effectively deliver chemotherapy directly to these cells.

BCL-2 Inhibitors

Venetoclax (Venclexta) inhibits the BCL-2 protein, which is responsible for cancer cell survival, thereby inducing cell death.

Hedgehog Pathway Inhibitors

For patients over 75 or those for whom chemotherapy poses significant risks, drugs like Glasdegib (Daurismo) may regulate essential signaling pathways that enable normal cell function.

Refractory AML: What Does It Mean?

Refractory AML is diagnosed when a patient does not achieve remission after one or two cycles of induction chemotherapy, signifying a persistent blast count of 5 percent or more. This condition affects 10 to 40 percent of AML patients, necessitating alternative courses of treatment or participation in clinical trials.

Understanding Remission

Remission implies the absence of disease symptoms following treatment, which is characterized by:

  • Fewer than 5 percent blast cells in the bone marrow.
  • Blood cell counts returning to normal ranges.
  • No observable signs or symptoms of leukemia.

An ideal scenario is termed complete molecular remission, where sensitive testing reveals no leukemia cells. Patients will require ongoing follow-up care post-remission to monitor for potential relapse.

Conclusion

While chemotherapy is central to AML management, diverse treatment avenues are available, depending on the disease's subtype, genetic mutations, and the patient's response to preliminary therapies. Collaborating with your treatment team ensures a personalized approach to effectively manage your health condition.

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