Induction treatments for acute myelogenous leukemia

Induction treatment is also called remission induction therapy. The goal of induction treatment for acute myelogenous leukemia (AML) is to clear the blood and bone marrow of immature blood cells (called blast cells, or blasts) and bring about a complete remission, or complete response. This treatment is usually given over 1 week.

Chemotherapy

Chemotherapy is the main induction treatment for AML. Most regimens are built around the drug cytarabine (Cytosar, Ara-C) and daunorubicin (Cerubidine), which may be combined with other drugs or agents.

Common chemotherapy protocols

Most regimens include cytarabine combined with anti-tumour antibiotics. These drugs are usually given in the 7-and-3 protocol. Cytarabine is given continuously for 7 days and then the anti-tumour antibiotic is given daily for 3 days. The anti-tumour antibiotics used in the 7-and-3 protocol include:

  • daunorubicin
  • idarubicin (Idamycin)
  • mitoxantrone (Novantrone)

Other chemotherapy regimens used as induction treatment for AML include:

  • cytarabine, daunorubicin and thioguanine (Lanvis, 6-TG)
  • high-dose cytarabine (HDAC)given alone or in combination with other drugs

Older people with AML who may not benefit from standard therapy or who cannot cope with the side effects of the drugs commonly used in induction treatment may be given low-dose cytarabine or azacitidine (Vidaza).

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 induction chemotherapy regimen for people with leukemia cells that have a certain genetic mutation called FLT3. This drug is called midostaurin (Rydapt).

Chemotherapy for minimal residual disease

After the first course of chemotherapy, some people with AML have minimal residual disease (MRD). MRD means that there are still leukemia cells in the bone marrow. People with MRD are usually given a second course of chemotherapy. The second course may use the same or similar drugs given in the first course if there are fewer leukemia cells in the bone marrow than before treatment started. Doctors may use a different chemotherapy regimen if there are still a large number of leukemia cells in the bone marrow after the first course of chemotherapy.

Some people may be given high-dose cytarabine (HDAC) alone as a first or second course of chemotherapy if they have a history of cardiac disease.

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.

Supportive therapy

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

Supportive therapies given during induction treatment may include:

  • antibiotics, antivirals or antifungals to prevent or fight 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
  • drugs to bring down high levels of some chemicals in the blood that increase when many cancer cells die at the beginning of treatment (called tumour lysis syndrome)
  • leukapheresis to remove large numbers of white blood cells from the blood

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.