Acute Myeloid Leukemia (AML): Chemotherapy 

What is chemotherapy?

Chemotherapy uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

When might chemotherapy be used for AML?

Chemotherapy is the main treatment for nearly all people with acute lymphocytic leukemia (AML). It isn’t used for some people with a subtype of AML known as acute promyelocytic leukemia (APL). 

If the first treatment with chemotherapy doesn't work, your doctor may advise another type of chemotherapy. This might be given in high doses along with a stem cell transplant. This depends on a variety of factors, such as your age and if the first treatment worked at all.

How is chemotherapy given for AML?

If you get chemotherapy, you will likely meet with a hematologist/oncologist before treatment starts. This doctor specializes in treating blood cancers like leukemia with chemotherapy. The doctor will talk with you about your treatment and what you might expect.

Chemotherapy for AML is often given in phases. This gives the medicines a better chance of working well. The treatment phases of AML include:

  • Remission induction. The goal of this phase is to quickly kill as many leukemia cells in the blood and bone marrow as possible. This usually puts the leukemia into remission. Remission means you don't have signs or symptoms of the cancer.

  • Consolidation (intensification) therapy. The goal of this phase is to kill any remaining leukemia cells and keep you in remission.

Chemotherapy in the first two phases can be intense. You may need to spend some time in the hospital. Younger patients often get stronger chemotherapy. Older patients may get slightly less strong treatment.

Treatment in the remission induction phase

During this first phase of treatment, you will likely need to stay in the hospital. You may be kept in isolation. This is to help protect you from other people's germs. You get chemotherapy through a vein (IV). You usually get a combination of 2 medicines. This makes it more likely that the treatment will work well. Which medicines you get and how long you receive them depends on factors such as your age and overall health.

You’ll likely receive the medicine cytarabine for 7 days. Your doctor will likely combine this with 3 days of an anthracycline medicine such as  daunorubicin or  idarubicin. This 7-day plus 3-day protocol puts the leukemia cells in contact with medicines at different phases of their growth. This makes it more likely that the cells will be killed. Your doctor may also add another medicine.

You may also get blood product transfusions during this time if your blood cell counts get too low. Your healthcare team will check you closely for side effects. Side effects are more likely if you get high doses of medicines.

A few weeks after treatment, you will have a bone marrow biopsy and aspiration. This is done to look for any leukemia cells that remain. If there are still leukemia cells in your bone marrow, you may have a second course of chemotherapy. This is done to try to put the leukemia into remission.

Treatment in the consolidation (intensification) phase

Once your leukemia is in remission, the next phase of treatment is consolidation. This is an intense course of chemotherapy. It’s done to try to kill any remaining cancer cells. The goal of this phase of treatment is to keep you in remission or to prevent relapse. You may get higher doses of chemotherapy medicines for several days. This will be repeated once a month for a few months. Another option may be very high-dose chemotherapy along with a stem cell transplant. Younger people usually have stronger chemotherapy. Older adults may have less-strong treatment.

What are common side effects of chemotherapy?

Chemotherapy medicines are designed to attack and kill cells that divide quickly, including cancer cells. These medicines can also affect normal cells that grow quickly. These include hair, and bone marrow cells where new blood cells are made. The side effects of chemotherapy are different for everyone. They usually go away when the treatment ends.

Chemotherapy for AML is typically given in high doses. This can often lead to serious side effects. These usually go away when the treatment ends. The side effects can be different for each person. The most common short-term side effects of chemotherapy for AML include:

  • Hair loss

  • Infections, from low levels of white blood cells

  • Easy bruising or bleeding, from low levels of blood platelets

  • Tiredness, from having low levels of red blood cells

  • Mouth sores

  • Loss of appetite

  • Nausea and vomiting

  • Inflammation of the membrane covering the eye and lining the eyelid (conjunctivitis)

A possible long-term severe side effect of chemotherapy is organ damage. The risk depends on the medicines used. It can include damage to the kidneys, liver, testicles, ovaries, brain, heart, or lungs. Doctors and nurses watch treatment closely to try to reduce the risk of these side effects.                                                                                                                                                                   

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, ask your healthcare team how they work, and what side effects they might have.

Talk with your healthcare providers about what signs to look for, and when to call them. Make sure you know what number to call with questions, even on evenings and weekends.

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your medical team to make a plan to manage your side effects.