Acute Myelogenous Leukemia (AML)

Physicians devise a course of treatment for each AML patient that takes a number of factors into consideration: the AML subtype; whether the patient has been treated already, with what, and how successfully; the number of leukemic cells detectable in the blood; which chromosomal alterations are present; and the patient's age and overall health. For this reason, AML patients with the same disease subtype may receive different treatments.

The standard treatment approaches for adult leukemia are chemotherapy, immunotherapy, and bone marrow transplantation. Radiation therapy -- treatment with high-energy rays that destroy cancer cells -- is sometimes used for leukemia in the central nervous system or elsewhere. But because leukemia is systemic, surgery is almost always ineffective.

Treatment for AML is typically divided into two phases: remission induction and post-remission therapy.

The goal of the remission induction phase is to induce a remission, a state in which there is no visible evidence of disease and blood counts are normal. Patients may receive a combination of drugs during this phase including daunorubicin, idarubicin, or mitoxantrone plus cytarabine and thioguanine.

In the next phase, the post-remission therapy phase, patients may receive high doses of chemotherapy, designed to eliminate any remaining leukemic cells. During this phase, treatment may include a combination of two or more of the agents cytarabine, daunorubicin, idarubicin, etoposide, cyclophosphamide, mitoxantrone, or cytarabine.

A stem cell or bone marrow transplant is an option for some AML patients; this procedure is done after an initial remission is achieved. In this procedure, bone marrow or stem cells -- blood-forming cells -- are filtered from the patient's (autologous transplantation) or a donor's (allogeneic transplantation) marrow or bloodstream and then frozen. The patient then receives a high dose of chemotherapy, which destroys tumor cells but also damages the stem cells in the patient's bone marrow. The harvested stem cells or marrow are then administered, or transplanted, to help rebuild the patient's immune system.