AML treatment options beyond intensive chemotherapy

Acute myeloid leukemia (AML) is an aggressive type of cancer that begins in the blood-forming cells found inside bone marrow.

Like other cancers, AML occurs when cells undergo mutations and begin to grow uncontrollably. AML causes the rapid and uncontrolled growth of immature white blood cells called myeloblasts (or blast cells). These cancerous cells remain stuck in an immature stage of development, do not function like normal white blood cells, and because they proliferate at a much faster rate than normal, leave few resources and little space for healthy cells in the bone marrow.

Treatment for AML

It’s recommended to begin treatment as soon as possible. As mentioned above, AML is considered an aggressive cancer. This means cancer cells multiply quickly, symptoms can worsen in a short amount of time, and the disease can progress quickly if it is left untreated. As AML progresses, leukemia cells can damage the bone marrow, cause scarring in the bone marrow, and travel to other parts of the body through the bloodstream.

Treatment is different for every individual, and a healthcare team will consider multiple factors when planning treatment:

• A person’s age. AML most often affects people over the age of 60. However, AML also affects younger adults and children.
• Overall health. This includes coexisting health conditions and previous cancers. Most people with AML are 60 years or older, and many are living with co-existing health conditions. Many people with AML have had another type of cancer previously.
• The subtype of AML. Subtypes with certain genetic abnormalities can respond better to different treatments.
• The number of leukemia cells in the blood. Very high numbers can cause problems with circulation (a condition called leukostasis) that requires urgent treatment.
• Whether the cancer has spread. AML can spread beyond the blood and bone marrow. For example, AML that has spread to the brain and/or spinal cord requires intrathecal chemotherapy, a specialized form of chemotherapy that is delivered into the layers of tissue that cover the brain and spinal cord. Radiation may also be used.

One of the most important factors is an individual’s risk and tolerance for treatment side effects—specifically, if a person is able to tolerate intensive chemotherapy.

Less-intensive therapies for AML

When possible, the main approach to treatment for AML involves intensive chemotherapy. A common approach is continuous chemotherapy over seven days, sometimes combined with targeted therapy drugs.

However, this approach is not right for everyone. For some, the risk of complications from intensive chemotherapy is greater than the potential benefits. Others may not be willing to undergo treatment that requires hospitalization and months of recovery, and what that means for their quality of life. Other treatment options may be a better fit.

Less-intensive induction therapy

Treatment for AML usually includes two phases, induction and consolidation.

During the induction phase, the goal is to eliminate as many leukemia cells as possible as quickly as possible. When intensive induction therapy is not an option, a person may receive lower doses of chemotherapy, targeted therapy, or a combination of the two:

• Lower-dose chemotherapy drugs or chemotherapy drugs called hypomethylating agents (HMAs).
• Targeted therapy, which can be used if cancer cells have specific gene mutations that create vulnerabilities to targeted therapy. These drugs act on substances cancer cells need to survive and grow.
• An antibody drug conjugate, which works like a combination of a targeted therapy and chemotherapy. The targeted therapy binds to a cancer cell to deliver the chemotherapy drug with precision.

Even when less-intensive therapies are used, these treatments still cause side effects, and supportive care to manage side effects is an essential part of treatment.

Less-intensive consolidation therapy

This phase begins when a cancer is in remission. The goal here is to eradicate any remaining cancer cells, which helps prevent the cancer from recurring after treatment. This can include additional rounds of chemotherapy and continuing targeted therapy (when targeted therapy was used for induction).

Consolidation may be followed by maintenance therapy, also known as post-consolidation therapy. This phase typically involves lower doses of cancer drugs taken for longer periods of time, to help prevent cancer from recurring.

Again, factors like those listed above will be considered when making decisions about these phases in treatment.

Non-myeloablative stem-cell transplant

A stem cell transplant using stem cells from a donor (allogenic transplant) or from healthy stem cells collected from a patient (autologous transplant) may be recommended.

These procedures involve intensive chemotherapy and/or radiation therapy to kill off all cancer cells and healthy stem cells in the bone marrow. This allows the transplanted stem cells to start over and rebuild the blood-forming abilities of the bone marrow.

If a person is not a candidate for one of these procedures, they may still be a candidate for a less-intensive treatment called a non-myeloablative stem-cell transplant. This is sometimes called a “mini transplant.” It requires a matching donor.

A non-myeloablative transplant involves lower doses of chemotherapy and/or radiation, which kill off some cancer cells and suppress the immune system to prevent the body from rejecting the transplanted stem cells. If successful, the transplanted stem cells will overtake and replace the cancerous cells.

You may want to consider a clinical trial

Treatment options for AML have expanded over the past decade, and new therapies and combinations of therapies are in development. Clinical trials may offer other potential treatments.

If this is something you are interested in, talk to your healthcare team, who will be your best source of information.