Treating AML

*Please note: This slide show represents a visual interpretation and is not intended to provide, nor substitute as, medical and/or clinical advice.

How is AML treated?

Acute myeloid leukemia (AML) is usually a fast-growing cancer of the bone marrow and blood. Because it can progress quickly, treatment often needs to start soon after it is diagnosed.

However, some forms of AML have a slower onset and treatment may be held while waiting on full results of diagnostic tests.

How is AML treated?

Several factors go into planning treatment for AML, including:

• Your age and general health
• Your subtype of AML
• If you are a candidate for a stem cell transplant
• The results of your chromosome and genetic testing
• Whether you have had treatment for AML before and how you responded to it.

Key terms used in AML treatment: Complete remission

Let’s define some of the terms used in AML treatment.

A goal in AML treatment is to achieve a complete response or remission. Remission means that

• Fewer than 5 out of 100 (5%) blood-forming cells in the bone marrow are blasts.
• No blasts are circulating in the blood.
• All blood cell counts are back to normal or near normal.

Key terms used in AML treatment: Complete remission

• But some abnormal cells may remain in the blood or bone marrow.
• Failure to achieve complete remission is called refractory or resistant AML.

Key terms used in AML treatment: Measurable residual disease (MRD)

Measurable residual disease, or MRD, means that highly sensitive tests find a small number of blast cells in the bone marrow that can’t be seen with the eyes.
MRD is sometimes also called minimal residual disease.

Undetectable MRD, means no disease is detected by these sensitive tests and means the outlook for the patient is better.

Key terms used in AML treatment: Hematologic recovery

Hematologic recovery means that

• Blood cell counts are normal or close to normal (partial or incomplete hematological recovery).
• In partial hematological recovery, it may be safe to be out of the hospital.
• You may still need blood transfusions until your counts are above the levels that require transfusion support.

Key terms used in AML treatment: Cytogenetic response

• A cytogenetic response means that chromosome studies detect no abnormal cells in the blood.
• Chromosome studies are sometimes called “karyotype.”
• Chromosome studies may be supplemented by a FISH test. FISH stands for fluorescence in situ hybridization. A FISH test looks for abnormal regions of chromosomes that are typical of AML.

Key terms used in AML treatment: Molecular response

A molecular response means that a PCR test finds no abnormal DNA in the blood or bone marrow. PCR stands for polymerase chain reaction. This test looks at individual molecules of DNA to find changes in genes or chromosomes.

What is chemotherapy for AML? Induction chemotherapy

Chemotherapy is a main treatment for most types of AML.

Chemotherapy for AML is sometimes given in two phases. The first phase is called induction.

The goal of induction therapy is to induce a complete response by killing as many leukemia cells as possible, getting blood cell counts back to normal, and removing all signs of cancer.

Induction therapy usually works better when at least two drugs are given together.

What is chemotherapy for AML? Consolidation chemotherapy

The second phase of chemotherapy for AML is called consolidation. This phase happens after remission.

The goal of consolidation therapy is to kill any leukemia cells left behind in the body. Without consolidation therapy, AML is likely to come back.

Chemotherapy for AML

Sometimes AML is not treated in two phases like this. Some patients, especially older patients, are treated with a single drug or a combination of drugs without a specific induction and consolidation phase. Examples include the drugs decitabine, azacitidine, and venetoclax.

What is a stem cell transplant?

In a stem cell transplant, a patient receives an infusion of healthy blood-forming cells from a donor after receiving high doses of chemotherapy, to empty the bone marrow of their own blood-forming cells.

Who is a candidate for a stem cell transplant?

Younger patients who are healthy, except for having AML, are often considered the best candidates for a stem cell transplant. But there is increasing experience with doing transplants in older patients. Even after a stem cell transplant, though, some risk remains that AML could come back.

What is targeted therapy for AML?

Targeted therapy uses drugs that take aim at certain parts of cancer cells, such as changes in genes that regulate normal development of blood cells. 

These drugs may work by themselves, but often work better when they are given with chemotherapy.

Targeted drugs usually don’t work unless a patient’s cancer has the specific abnormal gene that the drug targets.

Midostaurin, gilteritinib, enasidenib and ivosidenib are examples of targeted therapies for certain types of AML.

What can be done to treat AML that doesn’t go into remission or comes back?

When AML doesn’t go into remission, or it comes back, the U.S. Food and Drug Administration, or FDA, has approved several drugs that can be used to treat it.

What is the outlook after AML treatment?

The outlook, or prognosis, after treatment for AML often depends on age. Younger patients tend to have a better outlook than older ones, but this varies from patient to patient.

AML is harder to treat in older patients for several reasons.

• Older patients more often have other health problems.
• They are more likely to have had MDS or another type of cancer before they get AML.
• They are more likely to have gene abnormalities that make AML difficult to treat.

More questions about AML?

It’s important to discuss all your treatment options with your doctor or cancer care team, so you can make decisions that are right for you. Ask questions if there is anything you are not sure about.