Treatment of Acute Myeloid Leukaemia (AML)

Symptoms of AML develop quickly; a person is likely to become very ill with symptoms of their leukaemia over a few days or weeks. Symptoms of acute leukaemia are listed under symptoms. The initial diagnosis and treatment, including chemotherapy treatment is given as an in-patient in hospital, along with supportive care. Patients are usually inpatients for about 4 weeks and usually become very unwell from the side effects of the chemotherapy. Approximately 10% of patients will die during these first 4 weeks due to complications of the treatment. After one cycle of chemotherapy in hospital the leukaemia will often be in remission and the patient’s condition will usually be improved though they may still be weak and tired. This first cycle of chemotherapy to induce remission is often called induction chemotherapy. Without further ‘consolidation’ or ‘post remission’ chemotherapy median survival is about 4 months, this is because the leukaemia comes back quickly without further treatment. Survival can be improved with the following treatments:

• ‘Consolidation’ chemotherapy or ‘post remission’ chemotherapy – this is likely to include 1-4 cycles of INPATIENT chemotherapy. Patients are usually inpatients for about 4 weeks for each course of therapy and usually become very unwell from the side effects of the chemotherapy. Some patients will die of the complications of this treatment. Patients are usually only allowed 1 or 2 weeks break between cycles of treatment and will often be very weak and unable to do much for themselves when at home
• bone marrow or stem cell transplant in selected subtypes of

Chemotherapy regimes are likely to include several drugs at once and many patients will be on MRC (Medical Research Council) Trials. There are several trials in progress in the UK at this time including AML 15, 16 and 17. Entry onto the trial will depend on age, the status of the disease and the associated risk factors. The trials include the use of several treatment options that may include: DA, ADE, FLAG, FLAG IDA, MACE, MiDac Myelotarg and Clofarabine. Each letter in the acronym stands for a different drug used within that regimen, e.g. D for Daunorubicin and A for Arabinose Cytarabine. List of drugs:

• Cytarabine
• Daunorubicin
• Idarubicin
• Thioguanine
• Mitoxantrone
• Etoposide

Side effects associated with this treatment include:

• Myelopathy – damage to the spinal cord by drugs – numbness, tingling or difficulty moving are likely symptoms
• Peripheral neuropathy – numbness or tingling are common symptoms
• Fits
• Very severe tiredness
• Acute cerebellar syndrome – difficulty balancing when walking or difficulty walking at all are likely symptoms
• Pulmonary oedema – may cause shortness of breath

Other treatments used in addition to chemotherapy include:

• G-CSF e.g. Neupogen or Granocyte. (Granulocyte Colony Stimulating Factor) These are growth factors to stimulate the production of normal blood cells by the bone marrow.
• Steroid drugs including prednisolone, methylprednisolone and dexamethasone. These drugs are used in short bursts during chemotherapy treatment. In general side effects are minimal. However if used for prolonged periods the following side effects are very common – significant weight gain, osteoporosis and diabetes mellitus. Rarer side effects include psychiatric problems ranging from depression and anxiety to full blown psychotic episodes.

Long term side effects of chemotherapy treatment

Of note young people with leukaemia who become long term survivors are at high risk of the following long term side effects-:

• Infertility
• Second cancers
• Lung damage
• Heart disease
• Nerve damage

Click on the links for details of:

• Problems in adults who had cancer treatment as children
• Side effects of Chemotherapy
• Bone marrow transplant

Amended February 2009