Treatment for acute myeloid leukemia (AML) needs to begin as soon as possible after diagnosis to have the best chance of success. AML, also called acute myelogenous leukemia, is a blood cancer that begins in the bone marrow. AML is aggressive and fast-growing.

After you've been diagnosed with AML, your health care providers or cancer care team will discuss your treatment options with you. Your options may be influenced by which AML subtype you have. Several other prognostic factors, such as your age and general health, also inform your options for treating AML.

MyLeukemiaTeam sat down with Dr. Pemmaraju, associate professor in the department of leukemia at MD Anderson Cancer Center in Houston, to learn more about the types of treatment for AML.

The good news is there are more treatments available today than ever before. “There's a lot of hope,” Dr. Pemmaraju said about the available AML treatment options. “There have been several new approvals in the AML space.”

Thanks to progress in cancer research, a variety of treatment options and cancer-killing drugs exist for AML. Some treatments may be combined in a treatment plan, while others may be used alone as a single treatment, also known as monotherapy.

Chemotherapy

For most types of AML, the standard initial treatment is chemotherapy. Chemotherapy works by killing or damaging rapidly dividing cells in your body. These potent medications are toxic to cancer cells, but they also injure healthy cells.

A typical chemotherapy regimen for younger adults with most types of AML may comprise the following:

• Cytarabine
• An anthracycline, like Adriamycin (Doxorubicin) or Daunorubicin
• Fludarabine
• Cladribine
• Other agents

There are usually at least two phases of chemotherapy treatment for adults with AML: remission induction therapy and post-remission therapy. Note that acute promyelocytic leukemia, one subtype of AML, has a different treatment regimen from other AML types.

Remission Induction Therapy

Remission induction therapy is the first phase of chemotherapy treatment for adults diagnosed with AML for the first time. “Front-line or upfront treatment, especially with acute leukemia types, means you have never gotten chemotherapy before your induction chemotherapy,” explained Dr. Pemmaraju. The goal is to induce remission of the leukemia by destroying the leukemia cells in the blood and bone marrow.

When a treatment successfully kills off the majority of the leukemia cells, the cancer is said to be in remission. Remission is generally defined by one or more of the following criteria:

• The bone marrow contains less than 5 percent blast cells.
• Blood cell counts, specifically for neutrophils and platelets, have returned to normal levels.

About two-thirds of people go into remission after receiving induction chemotherapy. But several prognostic factors affect the success of a person’s treatment and the disease course of their AML.

Post-Remission Therapy

Post-remission therapy, also called consolidation or maintenance therapy, is started once leukemia is in remission. Post-remission therapy is designed to destroy any leukemia cells that survived the first phase of treatment. These remaining leukemia cells have the potential to regrow and cause the cancer to relapse. The specifics of a person's consolidation therapy depend on the risk of their leukemia coming back, in addition to other factors.

Clinical Trials

Dr. Pemmaraju treats people in his clinic, but he’s also active in clinical trial research. “Clinical trials are the number one recommendation for any patient with leukemia,” he told MyLeukemiaTeam. “I think there's a misconception that clinical trials are a person’s last-line therapies, when there's no other hope or other options. Clinical trials are very important for all phases of therapy.”

Dr. Pemmaraju explained more about clinical trials for AML at MD Anderson Cancer Center where he works. “People can actually get on a clinical trial for a new treatment. For AML there are front-line therapies with new drugs, old drugs in combination with new drugs, older drugs but with new parameters. Clinical trials are the heart of what my team and I do,” he explained.

Stem Cell Therapy

A stem cell transplant (SCT), or bone marrow transplant, involves an intravenous infusion of blood-forming stem cells to restore the bone marrow. That process is performed after a person undergoes rounds of high-dose chemotherapy — and sometimes radiation — designed to destroy the bone marrow.

Like all treatments for AML and leukemia, stem cell transplantation comes with possible risks and side effects, some of which are serious and sometimes life-threatening. Stem cell transplantation isn’t an option for all types of AML, nor is it an option for all people with AML. Older adults may not tolerate the intensive treatment involved with an SCT as well as younger adults can.

Targeted Therapy

Targeted therapies work differently from chemotherapy. Targeted therapy drugs disrupt specific parts of leukemia cells. Targeted drugs may help when chemo isn’t effective.

Sometimes, targeted therapies such as those listed below, are used in combination with low-intensity chemotherapy to treat AML:

• Rydapt (Midostaurin) for AML cells with an FLT3 gene mutation
• Xospata (Gilteritinib)
• Venclexta (Venetoclax)
• Daurismo (Glasdegib)

Other agents have recently been approved for specific AML cases:

• Mylotarg (Gemtuzumab ozogamicin), if the AML cells have the CD33 protein
• Tibsovo (Ivosidenib), if the AML cells have an IDH1 gene mutation
• Idhifa (Enasidenib), if the AML cells have an IDH2 gene mutation

“There have been multiple new approvals for targeted therapies for AML in particular,” Dr. Pemmaraju said. “In just the last two years, seven or eight oral targeted therapy drugs have been approved by the FDA.” Most targeted therapies can be taken at home. It may not be necessary to go to a clinic to receive this type of AML treatment.

Behavioral and Lifestyle Changes

Whether or not you are actively treating your AML, ensuring you’re in the best overall health can help you have a better quality of life. It may also increase your treatment options for leukemia.

Healthy eating and regular exercise (as appropriate for your abilities) can improve energy and mood, as well as help you recover faster from treatment or illness. If you smoke cigarettes, quitting smoking may help you live longer, reduce side effects and complications from cancer treatment, and speed recovery from the effects of treatment. Always consult your doctor before beginning a new diet or exercise plan.

Determining Your Treatment Plan

The best treatment plan for you will be the one you and your health care team agree on. Take an active role in learning about your AML and treatment options.

“One thing that's important is, it's your body, it's your life,” said Dr. Pemmaraju. “Get a second opinion, a third opinion, and synthesize all the information. There's an infinite amount of information out there. Read on the internet, go on social media platforms, and discuss the information you find with your health care provider, as it may or may not directly apply to you. Constant communication with your leukemia team during your leukemia journey is the key, as information changes quickly in this field. Your own health status may change quickly. Take advantage of the democratization and digitalization of information. I encourage all my patients to do this. ”

You Are Not Alone With Acute Myeloid Leukemia

If you or a loved one are undergoing treatment for AML, you are not alone. MyLeukemiaTeam is a community of people who support each other, offer tips, and share experiences.

What treatments are you using for your AML? What do you wish you had known about AML treatments when you were first diagnosed? Comment below or start a conversation on MyLeukemiaTeam.