Acute Myeloid Leukaemia treatment

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The treatment of leukemia varies depending, on the one hand, on the age and general condition of the patient and, on the other hand, on the genetic and molecular characteristics of the disease.

The only curative treatment for most cases of acute myeloid leukaemia is chemotherapy. However, this varies depending on the age and general condition of the patient, as well as the genetic and molecular characteristics of the disease.

Pharmacological treatment

While being treated with chemotherapy, other non-chemotherapy drug therapies are also applied to prevent adverse effects and avoid, for example, vomiting. Transfusions of red blood cells or platelets may also be used to prevent or treat possible complications that arise during treatment, as may antibiotics.

Intravenous chemotherapy bag

Intensive treatment with chemotherapy. It is indicated in the young patient who can tolerate this type of intensive therapy. The main objective of any treatment in leukemia is to eradicate the disease, which is called complete remission of the disease.

There are usually two phases: induction treatment for remission and post-remission or consolidation treatment.

  • Induction phase. This is based on intensive chemotherapy involving the administration of various intravenous chemotherapy agents to eradicate leukaemia cells from the blood and bone marrow (complete remission), allowing the recovery of bone marrow function and the normal production of healthy blood cells.
  • Consolidation phase. This consists of additional cycles of chemotherapy to destroy any residual leukaemia cells (even if these are not observed under the microscope), because if no further treatment is received, there may be a relapse. It consists of more cycles of chemotherapy in order to destroy residual leukemic cells (even if they are not seen under a microscope), since if they do not receive more treatment they can cause a relapse of the disease. In general, there are two postremission treatment options. One or the other option is chosen depending on the age and general condition of the patient, the type of leukemia, the response to previous treatment, as well as the availability of a compatible donor:

Acute promyelocytic leukaemia has a different, specific treatment to other AMLs. It consists of administering induction chemotherapy together with a differentiating agent (all-trans retinoic acid, ATRA), and then, consolidation chemotherapy and ATRA. Currently, combinations of ATRA with another non-chemotherapeutic agent (arsenic trioxide) with good results. This treatment is already being applied to acute promyelocytic leukemias of not high risk.

Blood collection from a bone marrow transplant patient

Attenuated treatment without chemotherapy. In patients older than 70 years of age or with one or more diseases, given the poor tolerance and significant adverse effects of intensive chemotherapy, in addition to the lower probability of AML response in elderly patients, different therapeutic strategies are adopted. The most commonly used are hypomethylating agents (not chemotherapy) that may be applied on an outpatient basis if the patient’s condition permits.

Attenuated treatment is aimed at delaying the progression of the disease, causing less toxicity and better quality of life for the patient.

New Therapies

Clinical trials are part of the cancer research process and are conducted to determine whether new treatments are tolerable and effective, or better than standard treatments.

When clinical trials show that a new treatment is better than the standard treatment, it may become the new standard treatment. The current standard treatments are based on clinical trials. Patients participating in clinical trials receive either the standard treatment or the new treatment. When the doctors at a centre have access to a clinical trial suitable for a patient, the patient may either participate in the clinical trial (which is normally expected to involve an additional benefit) or not participate in the trial and receive the standard treatment. Clinical trials available to a center vary over time.

Palliative treatment

Palliative treatment is not a curative treatment, but is aimed at alleviating the symptoms of the disease. It is usually administered orally or through transfusions of red blood cells. However, when there is discomfort or pain, analgesics are used to treat this symptom. Palliative care also helps relieve symptoms, including pain and the emotional and spiritual distress of patients and their families.

Treatment complications

The most common side effects of chemotherapy, as well as recommendations for alleviating them, can be found at the following link.

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Substantiated information by:

Laia Guardia Roca
Marina Díaz Beyá

Published: 8 April 2019
Updated: 8 April 2019

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