The primary treatment options for acute myeloid leukaemia (AML) include chemotherapy, targeted therapies and bone marrow transplant. The type of treatment you receive will depend on a number of different considerations, such as your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how acute myeloid leukaemia treatment works in the private health system.
Chemotherapy for acute myeloid leukaemiaChemotherapy
Chemotherapy is the primary treatment for acute myeloid leukaemia which uses a range of drugs to kill and slow the growth of AML cells.
Chemotherapy for acute myeloid leukaemia is delivered in two therapy phases known as induction and consolidation.
- Induction therapy – Usually delivered in a cycle of four to six weeks, induction therapy is an intense phase of treatment that aims to destroy as many abnormal white blood cells as possible. You will usually spend the duration of your induction treatment in the hospital, as well as some time afterwards, as this initial phase of treatment is very intensive and may cause infections and complications if not monitored closely
- Consolidation therapy – Consolidation therapy focuses on preventing the return of acute myeloid leukaemia and destroying any cancer cells that may remain after induction therapy
Common chemotherapy medicines
There are a number of different chemotherapy drugs that are used to treat acute myeloid leukaemia. You may receive a single drug or a combination of chemotherapy drugs which are delivered either through injection or in pill form. Some of the drugs used include:
This is a chemotherapy drug that works in two different ways to kill abnormal cells in the bone marrow: as a demethylating agent by preventing the methylation of DNA and limiting the growth and spread of cancer cells, and as an antimetabolite, which kills cancer cells by interfering with their ability to make DNA. Azacitidine may be given alone or in combination with other chemotherapy or targeted therapy drugs, and is given by subcutaneous injection under the skin.
This is part of a class of chemotherapy drugs called antimetabolites. They work by interfering with DNA production within cells, preventing their ability to divide and grow. It is delivered by intravenous infusion into the vein or subcutaneous injection under the skin and is usually given in combination with other chemotherapy or targeted therapy drugs.
Idarubicin and daunorubicin
These drugs are known as anthracyclines. They work by stopping cells from being able to make DNA and slowing or stopping the growth and spread of leukaemia cells. Idarubicin and daunorubicin are given by intravenous infusion.
Granulocyte colony stimulating factor (G-CSF)
This is not a chemotherapy drug but may give as part of your chemotherapy treatment to help promote the growth of normal white blood cells and reduce your risk of infection. It is given by subcutaneous injection under the skin.
Targeted therapies for acute myeloid leukaemiaTargeted therapies
Targeted therapies use specialised drugs to destroy AML cells by focusing on abnormalities found within cancer cells, while avoiding normal healthy cells. Before targeted therapies are used to treat your acute myeloid leukaemia, your cancer cells will be tested to see if this form of treatment may be helpful to you. Targeted therapies are more commonly used to treat chronic leukaemia but may be used to supplement treatment plans for acute leukaemia.
Common targeted therapy medicines
Common targeted therapy drugs which are used to treat acute myeloid leukaemia include:
This drug is known as a tyrosine kinase inhibitor, which is used to treat people with a FMS-like tyrosine kinase 3 (FLT3) mutation. It targets and blocks a protein on leukaemia cells, preventing the growth of leukaemia cells. It is given orally as a tablet once daily.
This drug works by directly binding and blocking a protein called BCL-2, which is found on leukaemia cells. When this protein is blocked, it causes the cancer cells to die. Venetoclax is given orally as a tablet or capsule once daily.
Bone marrow transplant for acute myeloid leukaemiaBone marrow transplant
Bone marrow transplants, which are also referred to as stem cell transplants, replace cancerous bone marrow with healthy stem cells that help stimulate the development of new, healthy bone marrow. In order to destroy leukaemia-producing bone marrow, you will first receive high doses of chemotherapy before the healthy stem cells are transplanted.
Not all people with acute myeloid leukaemia will require a bone marrow transplant. The need for transplant depends on the risk of relapse which is assessed on an individual basis related to the genetics of their leukaemia.
Bone marrow transplants for acute myeloid leukaemia are done with cells donated from another person, this is known as an allogenic transplant. The donor must be a match to donate but may be a relative or an unrelated donor found through an international search. A bone marrow transplant involves giving high doses of chemotherapy with or without radiotherapy followed by the infusion of donor stem cells into your bloodstream.
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As the traditional cancer staging system is not used to stage AML, treatment for acute myeloid leukaemia instead focuses on a two-phase approach which includes chemotherapy and, in some cases, a bone marrow transplant. Targeted therapy drugs may also be used to support your treatment plan.
When the number of leukaemia cells in your blood are very high, treatment may be needed before your chemotherapy begins. To lower your leukaemia cell levels, you may receive leukapheresis treatment which involves passing your blood through a machine to remove white blood cells and returning the remaining blood back to your body.
If your AML does not respond to treatment and becomes advanced, the disease may no longer be considered curable and treatment will focus on palliative care to relieve your symptoms and manage your pain.
- National Cancer Institute. (2021, October 1). Acute myeloid leukemia treatment. National Cancer Institute. Retrieved December 22, 2021, from http://www.cancer.gov/types/leukemia/patient/adult-aml-treatment-pdq
- American Society of Clinical Oncology. (2019, May 6). Leukemia – acute myeloid – AML: treatment options. Cancer.Net. Retrieved December 22, 2021, from http://www.cancer.net/cancer-types/leukemia-acute-myeloid-aml/treatment-options
- Leukaemia Foundation. (2020, June 4). Acute myeloid leukaemia treatment. Leukaemia Foundation. Retrieved December 22, 2021, from http://www.leukaemia.org.au/blood-cancer-information/types-of-blood-cancer/leukaemia/acute-myeloid-leukemia/acute-myeloid-leukaemia-treatment/
- European Society of Medical Oncology (ESMO). (2020). Heuser, Y. Ofran, N. Boissel, S. Brunet Mauri, C. Craddock, J. Janssen, A. Wierzbowska & C. Buske, on behalf of the ESMO Guidelines Committee. Clinical Practice Guidelines – Acute Myeloid Leukaemia in Adult Patients
- National Comprehensive Cancer Network (NCCN). (2022) Guidelines for Patients. Acute Myeloid Leukaemia. Retrieved 17 February 2022 from https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1411
- Cancer Institute of NSW. EviQ. Acute Myeloid Leukaemia. Retrieved 17 February 2022 from https://www.eviq.org.au/haematology-and-bmt/leukaemias/acute-myeloid-leukaemia
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