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Chemotherapy for Acute Myeloid Leukemia

The goal of chemotherapy is to use drugs to kill cancer cells. It is a type of systemic treatment, which means the drugs travel throughout your body in your bloodstream. Chemotherapy works by disrupting cell growth and preventing cell reproduction. Its goal is to kill enough cancer cells to put the disease into remission and keep it there. Remission is when there are no longer signs or symptoms of cancer.

Chemotherapy is the first choice of treatment for acute myeloid leukemia (AML). If it doesn't work, your doctor may suggest another type of chemotherapy possibly with a stem cell transplant. This depends on a variety of factors, such as your age, how quickly you relapse, and whether or not your leukemia is resistant to treatment.  

What happens during chemotherapy for AML

You may get chemotherapy during different phases of your treatment. The process may be relatively the same, but the types of drugs you get may change.

Chemotherapy for remission induction

The goal of remission induction is to kill leukemia cells so you no longer have symptoms. During this first phase of treatment, you will likely need to stay in the hospital and you may be in isolation. You receive chemotherapy intravenously. You usually take more than one drug at a time, which is called combination therapy. This reduces the chance that the cancer will develop a resistance to one drug and improves the chance of successful treatment. Which drugs you get, as well as how long you receive them, will depend on many factors, including your general health and age.

During this first phase of treatment, you are likely to receive cytosine arabinoside (also known as cytarabine or Ara-C) continuously for seven days. Your doctor will likely combine this with three days of an anthracycline drug that you'll also get intravenously. This seven-day plus three-day protocol exposes the leukemia cells to drugs at various phases of their development, improving the success of killing the cells. Your doctor may also add other drugs. You may also receive drugs that help lower your chance of infection. They do this by stimulating white blood cell production. These drugs include colony-stimulating factors.

These are examples of drugs you may receive during the first phase of treatment:

  • Ara-C (cytarabine)

  • Anthracycline drugs such as Daunomycin (daunorubicin) or Idamycin (idarubicin)

  • Neupogen or Leukine (colony-stimulating factors)

Your doctor will check you closely for side effects. You are more likely to have side effects if you receive high doses of therapy during this and other phases of treatment.

When you need a second course of induction chemotherapy

About two weeks after you complete treatment, a doctor performs a bone marrow biopsy and aspiration. This is a way for your doctor to see whether leukemia is still present. If so, you may receive a second similar course of chemotherapy. It will last fewer days than the first time.

Chemotherapy for postremission (consolidation) therapy

The goal of this phase of treatment is to keep you in remission or to prevent relapse. Even people who achieve complete remission need a second phase of treatment, called consolidation, to help prevent relapse. This phase of treatment destroys any leukemia cells that are left. You may have higher doses of chemotherapy drugs for several days, which is repeated once a month for a few months. Another option may be very high-dose chemotherapy with a stem cell transplant. 

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