Consolidation treatments for acute myelogenous leukemia

Consolidation treatment is also called post-remission therapy. The goal of consolidation treatment for acute myelogenous leukemia (AML) is to prevent leukemia cells from coming back. It is done to maintain complete remission and prevent relapse.

Chemotherapy

Chemotherapy is the main consolidation treatment for AML. Chemotherapy is given soon after remission has been reached (2–3 weeks after blood cell counts return to normal).

Treatment involves repeating cycles of the same or similar drugs used to bring about the remission. Similar or higher doses of the drugs may be used.

The most common consolidation regimens for AML include cytarabine (Cytosar, Ara-C) alone or combined with an anti-tumour antibiotic such as:

  • daunorubicin (Cerubidine)
  • idarubicin (Idamycin)
  • mitoxantrone (Novantrone)
  • thioguanine (Lanvis, 6-TG)

Other regimens include:

  • high-dose cytarabine (HDAC) alone
  • azacitidine (Vidaza) for older people

Targeted therapy

Targeted therapy is treatment that uses drugs or other substances to target specific molecules (usually proteins) involved in cancer cell growth while limiting harm to normal cells.

A targeted therapy drug called a tyrosine kinase inhibitor may be added to the consolidation chemotherapy regimen for people with leukemia cells that have a certain genetic mutation called FLT3. This drug is called midostaurin (Rydapt).

Central nervous system treatment

The central nervous system (CNS) is the brain and spinal cord. If the leukemia has spread to the CNS, treatment may include chemotherapy given directly into the spinal fluid (called intrathecal chemotherapy). The drug used in intrathecal chemotherapy is methotrexate or cytarabine. It is given during a lumbar puncture or through an Ommaya reservoir.

Radiation therapy is sometimes given to the brain and spinal cord along with intrathecal chemotherapy.

Stem cell transplant

You may be offered a stem cell transplant for consolidation therapy for AML. The preferred type of transplant is an allogeneic transplant if a matched donor is available. If a matched donor is not available, autologous stem cell transplant may be an option for some people.

Radiation therapy

Radiation therapy may be given as part of the conditioning treatment before stem cell transplant. It may also be used to treat AML that has spread to the central nervous system.

Supportive therapy

Supportive therapy is important during every phase of AML treatment. It is used to treat the complications that usually happen with treatments for AML and the disease itself.

Supportive therapies given during consolidation treatment may include:

  • antibiotics and antifungals to treat infections
  • growth factors to help the bone marrow recover from chemotherapy (chemotherapy can affect the bone marrow so it doesn’t make enough healthy blood cells, which can increase the risk for infection)
  • transfusions of red blood cells, platelets, fresh frozen plasma and cryoprecipitate (a product that replaces clotting factors) as needed

Clinical trials

You may be asked if you want to join a clinical trial for AML. Find out more about clinical trials.

Expert review and references

  • American Society of Clinical Oncology (ASCO). Leukemia - Acute Myeloid - AML: Treatment Options. Alexandria, VA.: American Society of Clinical Oncology (ASCO); 2013: http://www.cancer.net/cancer-types/leukemia-acute-myeloid-aml/treatment-options.
  • Kebriaei P, Champlin R, de Lima M, et al . Management of acute leukemias. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014: 131: pp. 1928-1954.
  • Kurtin SE . Leukemia and myelodysplastic syndromes. Yarbro, CH, Wujcki D, & Holmes Gobel B. (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 57: pp. 1369-1398.
  • National Cancer Institute. Adult Acute Myeloid Leukemia Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014: http://www.cancer.gov.
  • Seiter K . Acute myelogenous leukemia treatment & management. eMedicine.Medscape.com. WebMD LLC; 2014.
  • Wiernik PH . Diagnosis and treatment of adult acute myeloid leukemia other than acute promyelocytic leukemia. Wiernik PH, Goldman JM, Dutcher JP & Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 22: pp. 375-401.