Acute myeloid leukaemia (AML) is an aggressive cancer that grows quickly, so treatment will usually begin a few days after a diagnosis has been confirmed.
As AML is a complex condition, it's usually treated by a group of different specialists working together called a multidisciplinary team (MDT).
Treatment for AML is often carried out in 2 stages:
- induction – this first stage of treatment aims to kill as many leukaemia cells in your blood and bone marrow as possible and treat any symptoms you may have
- consolidation – this stage aims to prevent the cancer coming back (relapsing) by killing any remaining leukaemia cells in your body
The induction stage of treatment is not always successful and sometimes needs to be repeated before consolidation can begin.
If you're thought to have a high risk of experiencing complications of AML treatment (for example, if you're over 75 or have another underlying health condition), less intensive chemotherapy treatment may be carried out.
Your doctors will watch you carefully and suggest other treatments if needed.
The initial treatment you have for AML will largely depend on whether you're fit enough to have intensive chemotherapy, or whether treatment at a lower dosage is recommended.
If you can have intensive induction chemotherapy, you'll be given chemotherapy medication at a high dose to kill the cancerous cells in your blood and bone marrow.
You'll usually be given a combination of 2 or more chemotherapy drugs.
Most people have 2 rounds of induction chemotherapy.
The treatment will be carried out in hospital or in a specialist centre, as you'll need very close medical and nursing supervision.
You may be able to go home between treatment rounds.
You'll have regular blood transfusions because your blood will not contain enough healthy blood cells.
You'll also be vulnerable to infection, so it's important that you're in a clean and stable environment where your health can be carefully monitored and any infection you have can be treated quickly.
You may also be prescribed antibiotics to help prevent infections.
For intensive treatment, the chemotherapy medications will be injected into a thin tube that's inserted either into a blood vessel near your heart or into your arm.
Side effects of intensive chemotherapy for AML are common.
They can include:
- feeling or being sick
- bruising or bleeding easily
- loss of appetite
- sore mouth and mouth ulcers (mucositis)
- skin rashes
- hair loss
- infertility – this may be temporary or permanent (see complications of AML for more information)
Most side effects should resolve once treatment has finished. Tell a member of your care team if side effects become particularly troublesome, as there are medicines that can help you cope better with certain side effects.
If your doctors do not think you're fit enough to withstand the effects of intensive chemotherapy, they may recommend non-intensive treatment.
This involves using an alternative type of chemotherapy to the standard intensive therapy.
The medications used during non-intensive chemotherapy may be given through a drip into a vein, by mouth or by injection under the skin, and can often be given on an outpatient basis.
If you have the type of AML known as acute promyelocytic leukaemia, you'll usually be given other drugs as well as having chemotherapy.
The 2 drugs most commonly used are:
- all tans retinoic acid (ATRA) – usually given during and after induction chemotherapy, it changes immature white blood cells into healthy mature cells, and can reduce symptoms quickly
- arsenic trioxide – usually given if the AML has come back, it speeds up the death of leukaemia cells and changes the immature blood cells into healthy mature cells
If there's no AML left after induction chemotherapy, the next stage of treatment is consolidation.
This often involves receiving regular injections of chemotherapy medication that are usually given in hospital.
The consolidation phase of treatment lasts several months.
It's used to:
- prepare the body for a bone marrow or stem cell transplant
- treat advanced cases that have spread to the nervous system or brain, although this is uncommon
Side effects of radiotherapy can include hair loss, nausea and fatigue.
Most of the side effects should pass once your course of radiotherapy has been completed.
Bone marrow and stem cell transplants
If chemotherapy does not work, a possible alternative treatment option is a bone marrow or stem cell transplant.
Before transplantation can take place, the person receiving the transplant will need intensive high-dose chemotherapy, and possibly radiotherapy, to destroy the cells in their bone marrow.
The donated stem cells are given through a tube into a blood vessel (a drip) in a similar way to chemotherapy medication.
You'll need to stay in hospital for a few weeks after the transplant, usually in a room on your own, because you'll have a high chance of getting infections.
Your friends and family should be able to visit you, but they'll need to wear protective clothing.
Transplantations have better outcomes if the donor has the same tissue type as the person receiving the donation.
The best candidate to provide a donation is usually a brother or sister with the same tissue type.
In the UK, a number of clinical trials are currently underway that aim to find the best way of treating AML.
Clinical trials are studies that use new and experimental techniques to see how well they work in treating, and possibly curing, AML.
As part of your treatment, your care team may suggest taking part in a clinical trial to help researchers learn more about the best way to treat your AML, and AML in general.
If you take part in a clinical trial, you may be offered medication that's not licensed for use in the UK and is not normally available.
But there's no guarantee that the techniques being studied in the clinical trial will work better than current treatments.
Your care team can tell you whether there are any clinical trials available in your area, and can explain the benefits and risks involved.
Cancer Research UK has more information on research into AML.
A treatment team for AML may include a:
- haematologist (blood cancer specialist)
- haemato-pathologist (specialist in the study of cancerous blood cells)
- paediatrician (specialist in treating children)
- cancer nurse specialist (sometimes called a CNS), who will be the first point of contact between you and the members of your care team
- radiologist (specialist in X-rays and scans)
- social worker