Treatment for acute myeloid leukaemia

When there is no sign of the leukaemia and the marrow is working normally this is called remission. For some people with AML the remission lasts indefinitely and the person is said to be cured.

Chemotherapy| is the main treatment used. Research has shown that certain types of chemotherapy drugs can be very effective in treating AML. These drugs are usually given in combination. In some situations high-dose chemotherapy and a stem cell or bone marrow transplant| are used to improve the chances of curing the leukaemia.

People who have a type of AML called acute promyelocytic leukaemia (APL) are usually treated with a drug called ATRA (All Trans-Retinoic Acid)|. It is a specialised form of vitamin A and is also known as tretinoin (Vesanoid®). ATRA is given for up to three months alongside chemotherapy treatment. It makes the leukaemia cells mature (differentiate), and so can reduce leukaemia symptoms very quickly.

Your doctor will plan your treatment by taking into account a number of factors including your age, general health, and the type of abnormal genes that are present in the leukaemia cells.

AML trials Back to top

Most people who are under 60 with AML will be asked if they would like to take part in the AML-17 trial. This trial is comparing the effectiveness of the current treatments used for AML and how many courses of treatment are needed. People aged 60 and over may be invited to take part if they are fit enough for intensive chemotherapy.

The AML-17 trial is also looking at the treatment of acute promyelocytic leukemia. This trial is also aimed at people younger than 60; however older people who are fit enough for intensive treatment may be invited to take part.

There is also a trial designed for people over 60 with AML: the AML-16 trial. This has 2 groups. The first is for fitter people who will be able to have intensive treatment. It is also looking at the role of bone marrow transplant and new drugs. The second group is for people for whom intensive therapy isn’t suitable and it compares standard treatment with new drugs.

Other trials are also underway looking into the use of newer drugs to treat AML. Your doctor may ask you to take part in one of these trials. You’ll be given written information about any trial in which you’re invited to take part.

See the clinical trials section| for more information about acute myeloid leukaemia trials.

If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse. It’s often useful to make a list of questions for your doctor and to take a relative or close friend with you.

Second opinion Back to top

Your multidisciplinary team uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. As treatment for AML should usually be started as soon as possible there may not be time to arrange this. If you would like a second opinion, it’s a good idea to discuss this with your specialist when you first see them.

If you do go for a second opinion, it may be a good idea to take a friend or relative with you, and have a list of questions ready so that you can make sure your concerns are covered during the discussion.

Giving your consent Back to top

Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:

• the type and extent of the treatment
• its advantages and disadvantages
• any significant risks or side effects
• other treatments that may be available.

If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Treatments for leukaemia can be complex, so it’s not unusual for people to need repeated explanations.

It’s a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.

Patients often feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.

You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.

You’re also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.

Benefits and disadvantages of treatment Back to top

The possible benefits of treatment vary depending on each individual situation.

Most people under 60 with AML are offered intensive chemotherapy. For some people this will cure the leukaemia, but it involves spending long periods of time in hospital – often several weeks – and can cause side effects. Most of these side effects| are temporary and can usually be controlled with medicines. However some, such as effects on fertility|, may be permanent for some people.

Some people over 60 will have intensive chemotherapy to try to cure the leukaemia. However, not everyone will be fit enough to undergo this. Also, some people may not want to have it. Instead they may have lower doses of chemotherapy to control the leukaemia cells in the bone marrow rather than try to get rid of them completely. This treatment can often be given as an outpatient so less time is spent in hospital. The chances of the disease going into remission are lower with this treatment.

Sometimes leukaemia doesn’t respond well to treatment or the treatment controlling it stops being effective. Some people choose not to have treatment. In these situations you can still be given supportive (palliative) care, with medicines and transfusions to help control symptoms.

Your haematologist is the best person to discuss your situation with. In some hospitals, specialist nurses are available to talk over all the possible benefits and side effects of treatment.