Treatment for acute myeloid leukaemia (AML)
Treatment for AML aims to destroy the leukaemia cells and allow the bone marrow to work normally again. When there is no sign of the leukaemia and the bone 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 treatment and a stem cell or bone marrow transplant are used to improve the chances of curing the leukaemia.
Planning your treatment
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Your treatment will be planned by a team of specialists who will meet to discuss and agree on the plan of treatment they feel is best for you.
This multidisciplinary team normally includes:
one or more haematologists
specialist nurses, who give information and support
pathologists, who advise on the type and extent of the leukaemia
a clinical oncologist, who specialises in radiotherapy and chemotherapy.
The team may also include other healthcare staff, such as social workers, dietitians, counsellors and physiotherapists.
The team will plan your treatment by taking into account a number of factors including your general health, and the type of abnormal genes that are present in the leukaemia cells. They will explain the plan to you and answer any questions you have.
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, but there are other trials specifically for older patients.
Other trials looking into the use of newer drugs to treat AML are underway.
We have more information about clinical trials.
Acute promyelocytic 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, and so can reduce leukaemia symptoms very quickly.
People with APL can also enter the AML-17 trial. It’s aimed at people younger than 60, however, older people who are fit enough for intensive treatment may be invited to take part.
Treatment for AML may cause temporary or permanent infertility. Before treatment starts, your doctor will discuss this with you, along with some of the things that can be done to preserve your fertility.
Before you have any treatment, your doctor will explain its aims. They will 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
any 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. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend 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.
People sometimes 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 are 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.
Advantages and disadvantages of treatment
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The possible advantages of treatment vary depending on each individual situation.
Most people under 60 with AML are offered intensive chemotherapy. This 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, intensive chemotherapy will cure the leukaemia, but others may not respond to the treatment. This means that some people may experience the difficult side effects of treatment without any of the benefits.
Some people over 60 will have intensive chemotherapy to try to cure the leukaemia. However, not everyone will be fit enough to go through this, and some people may choose not 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.
For people that do have treatment, sometimes the leukaemia doesn’t respond well or the treatment controlling it stops being effective. In these situations, you can still be given supportive (palliative) care to help control your symptoms.
Making treatment decisions can be difficult. 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.
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.
Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you. Have a list of questions ready, so that you can make sure your concerns are covered during the discussion.