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Chemotherapy for acute myeloid leukaemia (AML)

Chemotherapy is the main treatment for acute myeloid leukaemia (AML). Find out about how it is given and the possible side effects.

You will probably have to stay in hospital whilst having chemotherapy for AML. This is because:

  • it's demanding treatment
  • you have side effects that the hospital staff will help you with
  • you might need antibiotics into a vein to treat infection

What chemotherapy is

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

Phases of treatment for AML

Your treatment is in two phases:

  • getting rid of the AML (induction)
  • treatment to stop AML coming back (consolidation)

Getting rid of the AML (induction)

The aim of induction is to destroy the leukaemia cells.

When you have treatment

You have 2 or more different chemotherapy drugs in cycles of treatment. You have treatment for a few days, then a rest period. After the rest period, you might have more treatment.

Types of chemotherapy

You usually have a combination of 2 or more chemotherapy drugs to get rid of the leukaemia cells. The 2 main drugs are:
  • cytarabine
  • daunorubicin
You might also have:
  • idarubicin
  • mitoxantrone
  • etoposide
  • thioguanine
  • fludarabine

Treatment to stop AML coming back (consolidation)

When there are no signs of the leukaemia it is in remission. You have treatment to stop it coming back (consolidation).

When you have treatment

There are different types of consolidation treatment. Your team will tell you which combination of drugs you will have and when you will have them.

Types of chemotherapy

You normally have a combination of drugs. These include:
  • amsacrine
  • high dose cytarabine
  • etoposide
  • daunorubicin
  • fludarabine
  • idarubicin

Some people have high dose chemotherapy and then a bone marrow or stem cell transplant.

Treatment for APL

Acute promyelocytic leukemia (APL) is also known as AML type M3. It is treated differently to other types of AML. As well as chemotherapy you have other drugs.

Tretinoin

Tretinoin is also called ATRA, which stands for all trans retenoic acid. It is not chemotherapy but is made from vitamin A. You might have tretinoin alongside the standard chemotherapy treatments for AML. 

Tretinoin lowers the risk of bleeding from chemotherapy and makes your APL more likely to go into remission.

You take it after your leukaemia has gone into remission too, which is known as a maintenance treatment.

Arsenic trioxide

Arsenic trioxide is a drug that works by speeding up the death of leukaemic cells. It also encourages normal blood cells to mature properly. 

You are most likely to have this treatment if your APL has not gone into remission or has come back.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start your treatment. You have these either a few days before or on the day your treatment begins. You have blood tests before each round or cycle of treatment.

How you have chemotherapy for AML

You usually have chemotherapy directly into your bloodstream for AML.

You need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or in your arm. It stays in while you are having treatment.

You might have cytarabine as a small injection just under the skin (subcutaneously).

Side effects

Treatment for AML can cause side effects.

Clinical trials

Dietary or herbal supplements

We don't yet know much scientifically about how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

It is very important to tell your doctors if you take any supplements, or if you are prescribed them by alternative or complementary therapy practitioners. 

Talk to your specialist about any other tablets or medicines you take while you are having active treatment.

Some studies seem to suggest that fish oil preparations might make some chemotherapy drugs work less well. If you take or are thinking of taking these supplements, talk to your doctor to find out whether they could affect your treatment.

Last reviewed: 
14 Apr 2016
  • Acute Myeloblastic Leukaemia in Adult Patients: ESMO Clinical Practice Guidelines

    M Fey and C Buske, 2013

    Annuals of oncology. Volume 24, Issue 6
     

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