blood disorders
Acute Myeloid Leukemia (AML)
Treatment of AML
Chemotherapy Stem cell transplantation Treatment of AML is aimed at bringing about prompt remission—the destruction of the vast majority of leukemia cells. However, treatment often makes people sicker before they get better. Treatment suppresses bone marrow activity, resulting in very few white blood cells, particularly White Blood Cells . Having too few neutrophils makes infection likely. Treatment also disrupts the mucosae (such as the lining of the mouth), which makes it easier for bacteria to enter the body. Meticulous care is taken to prevent infections, and infections that occur must be promptly treated. Red blood cell and platelet transfusions are also needed. Inductionchemotherapy is the first phase of AML treatment. Chemotherapy drugs generally includecytarabinefor 7 days given by a continuous infusion anddaunorubicin(oridarubicin) given intravenously for 3 days. Other drugs that may be given includemidostaurinor gemtuzumab oxogamicin. In older adults or those with several medical problems, other drugs such asdecitabine,azacitidine,venetoclax, orglasdegibmay be used. Consolidationchemotherapy is given once AML is in remission. People usually receive several courses of additional chemotherapy beginning a few weeks after the initial treatment to help ensure that as many leukemia cells as possible are destroyed. Allogeneic Stem Cell Transplantation None Unlike in acute lymphocytic leukemia, preventive treatment to the brain usually is not needed for adults, and long-term lower-dose chemotherapy (maintenance therapy) has not been shown to improve survival. People with acute promyelocytic leukemia can be treated with a type ofvitamin Acalled all-trans-retinoic acid (tretinoin). Chemotherapy is frequently combined with the all-trans-retinoic acid, especially if the person has a high white blood cell count at the time of diagnosis or if the white blood cell count rises suddenly.Arsenic trioxideis also uniquely effective in this subtype of AML. People who have not responded to treatment and younger people who are in remission but who are likely to have a high rate of relapse (generally identified by certain chromosomal abnormalities) may be given high doses of chemotherapy drugs followed by Stem Cell Transplantation . When relapse occurs, additional chemotherapy for people unable to undergo stem cell transplantation is less effective and often poorly tolerated. Another course of chemotherapy is most effective in younger people and in people whose initial remission lasted longer than 1 year. Doctors take many factors into consideration when determining the advisability of additional intensive chemotherapy for people with AML in relapse. 