Chemotherapy for Acute Myeloid Leukemia in Adults

Doctors at NYU Langone’s Perlmutter Cancer Centermanage acute myeloid leukemia (AML) with a combination of chemotherapy drugs designed to kill fast-growing cancer cells. These drugs, which are given through a vein with intravenous (IV) infusion, destroy leukemia cells.

Chemotherapy is the first treatment our doctors offer for people who are diagnosed with AML. Because this type of leukemia grows quickly, our doctors start chemotherapy in the hospital as soon as possible.

Chemotherapy Treatment Phases

Chemotherapy for adults with AML involves several phases, each of which includes several cycles of treatment.

Induction

The goal of the first stage of treatment, called induction, is to achieve remission. This means doctors can’t detect any leukemia cells in the blood or in the bone marrow.

During induction, you receive a combination of chemotherapy drugs through a vein with IV infusion during a seven-day stay in the hospital. The most commonly used drugs are cytarabine, which stops the growth of cancer cells; and anthracycline, which prevents cancer cells from dividing, causing them to die.

Each seven-day infusion is followed by three treatment-free weeks in the hospital, where you are monitored for side effects.

Fourteen days after you start chemotherapy, your doctor may perform a bone marrow aspiration and biopsy, in which the bone marrow is checked for residual cancer cells, to determine whether treatment was successful. The test is performed again 28 days after chemotherapy starts to determine whether normal cells have grown back.

Reinduction

If you don’t achieve remission through induction, your doctor may recommend an additional phase of treatment, called reinduction, using the same or similar chemotherapy drugs and the same treatment schedule.

Consolidation

If remission is achieved during the induction or reinduction phases, the next phase, called consolidation, begins. It’s designed to kill any remaining microscopic leukemia cells that can’t be detected by blood tests. Left untreated, these cells can regrow, causing a relapse.

Based on the results of blood and tissue tests taken after induction, or your response to induction therapy, your doctor determines which treatment is appropriate. This can include additional rounds of chemotherapy.

A single round of chemotherapy involves three IV treatments over five days, and it is repeated every four weeks for a total of two to four rounds of chemotherapy.

If diagnostic tests predict a likely relapse despite treatments, you may receive an allogeneic stem cell transplant, in which your own cells are replaced with healthy stem cells from a donor.

Promyelocytic Leukemia Treatment

People with a type of AML called promyelocytic leukemia have a particular genetic mutation that blocks normal growth of immature cells called promyeloblasts. A chemotherapy drug called all-trans retinoic acid, or ATRA, may be used to prevent the mutation from hindering the growth of these cells.

This drug is a compound related to vitamin A. Taken by mouth, it targets the gene mutation that inhibits cell growth and allows the AML cells to mature into fully functioning cells called neutrophils. ATRA reduces the number of cancerous cells in the bone marrow, and can also reduce or stop severe bleeding associated with this type of leukemia.

Chemotherapy drugs or a form of arsenic may be used with ATRA to cause remission, when no cancer cells are detected in the blood.

Leukapheresis Treatment

Some people with AML have problems with circulation, which is caused by high numbers of leukemia cells in the blood. These cells may not respond to chemotherapy immediately. This condition, which is called hyperleukocytosis, can cause chest pain, weakness, vision changes, dizziness, and trouble breathing—and can lead to more serious symptoms, including a coma.

To reduce leukemia cells before chemotherapy begins, your doctor may perform a procedure called leukapheresis, in which excess white blood cells—including cancerous ones—are passed through a machine and removed from the blood. The remaining blood cells are returned to the body. Although the effect is temporary, it can help reduce the number of leukemia cells in the blood to give time for the chemotherapy to work.

Managing Side Effects

Chemotherapy is designed to attack cells that divide quickly, so it also affects healthy cells. The drugs can lower healthy blood cell levels and may lead to infection, easy bruising or bleeding, and fatigue. This is called cytopenia. As a result, your doctor may prescribe medications called growth factors to boost your blood cell levels, antibiotics to fight fever and infection, and blood transfusions.

These side effects usually disappear after chemotherapy is completed and healthy cells return to your body. To avoid infection, you may need to remain in a sterile environment, such as a special isolation room at NYU Langone. Only healthy friends or family are permitted to visit you.

Hair loss typically begins three to four weeks after the first round of chemotherapy. Hair grows back after treatment ends. Supportive services at Perlmutter Cancer Center can help you cope with the psychosocial effects of losing your hair, as well as other side effects.