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The aim of treatment for acute myeloid leukaemia (AML) is to destroy the leukaemia cells and allow the bone marrow to work normally again. When there is no sign of the leukaemia and the marrow is working normally this is called remission. For many people with AML the remission lasts indefinitely and the person is said to be cured.
Chemotherapy is the main treatment used. Research has shown that certain types of chemotherapy drugs can be very effective in treating AML. These drugs are usually given in combination. Most people with acute myeloid leukaemia go into remission after chemotherapy, and many people are cured.
In some situations high-dose chemotherapy and a stem cell or bone marrow transplant are used to improve the chances of curing the leukaemia.
People who have a type of AML called acute promyelocytic leukaemia (APL) are usually treated with a drug called ATRA (All Trans-Retinoic Acid). It is a specialised form of vitamin A and is also known as tretinoin (Vesanoid®).
ATRA is given for up to three months alongside chemotherapy treatment. It makes the leukaemia cells mature (differentiate), and so can reduce leukaemia symptoms very quickly.
Your doctor will plan your treatment by taking into account a number of factors, including your age, general health, and the type of abnormal genes that are present in the leukaemia cells.
Most people who are under 60 with AML will be asked if they would like to take part in the AML-15 trial. This trial is comparing the effectiveness of the current treatments used for AML. People aged 60 and over may be invited to take part in this trial if they are fit enough for intensive chemotherapy.
There is also a trial designed for people over 60 with AML: the AML-16 trial. It is comparing the effectiveness of a number of different treatments for AML and uses slightly less intensive treatment.
Other trials are also underway looking into the use of newer drugs to treat AML. Your doctor may ask you to take part in one of these trials. You will be given written information about any trial in which you are invited to take part.
See the clinical trials section for more information about acute myeloid leukaemia trials.
If you have any questions about your treatment, don't be afraid to ask your doctor or nurse. It is often useful to make a list of questions for your doctor and to take a relative or close friend with you. The fill-in form on the last page may help.
Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors would normally be pleased to refer you to another specialist for this. However, a second opinion can sometimes take time to arrange. As treatment for AML should usually be started as soon as possible there may not be time to arrange this for you.
If you would like a second opinion, it is a good idea to discuss this with your specialist when you first see them.
Before you have treatment a doctor will explain its aims to you. Medical treatment can't be given to someone without their permission, so you will usually be asked to sign a form giving permission (consent) for the hospital staff to give you treatment. Before signing this, you should have been given full information about:
If you don't understand what you have been told, ask for things to be explained again. Treatments for leukaemia can be complex, so it is not unusual for people to need to go over things more than once.
There may be written information about your treatment, which you can take away and read in your own time. It often helps to have a friend or relative with you when the treatment is explained. They can help you to remember what has been said. You may also find it useful to write down a list of questions you want to ask before seeing the doctor.
You are also free to choose not to have treatment. It is important that you understand what may happen if you do not have treatment. The medical staff will need to record your decision in your medical notes.
The staff will be able explain what support may be available if this is your choice.
The possible benefits of treatment vary depending on each individual situation.
Most people under 60 with AML are offered intensive chemotherapy. For many people this will cure the leukaemia, but it involves spending periods of time in hospital and can cause side effects. Most of these side effects are temporary and can usually be controlled with medicines. However some, such as effects on fertility, may be permanent for some people.
Some people over the age of 60 will have intensive chemotherapy to try to cure the leukaemia. However, not everyone will be fit enough to undergo intensive treatment. Also, some people may not want to have it. Instead they may have lower doses of chemotherapy to control the leukaemia cells in the bone marrow rather than to try to get rid of them completely. This treatment can often be given as an outpatient so less time is spent in hospital. The chances of the disease going into remission are lower with this type of treatment.
If the leukaemia is at an advanced stage and treatment to control it is no longer helpful, or if you choose not to have treatment, you can still be given supportive (palliative) care, with medicines and transfusions to help to control symptoms.
Your haematologist is the best person to discuss your situation with. In some hospitals, specialist nurses are available to talk over all the possible benefits and side effects of treatment.
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