Consolidation treatments for acute myeloid leukemia

Consolidation is the second phase of treatment given for acute myeloid leukemia (AML). Consolidation treatment is given once remission is achieved. Consolidation treatment is also called post-remission therapy. The goal of consolidation treatment for AML is to kill any remaining leukemia cells in the body and prevent leukemia from coming back. It is done to maintain complete remission and prevent relapse.

Your healthcare team will suggest consolidation treatments based on your needs and work with you to develop a treatment plan. Some factors considered for your treatment include:

• how many cycles of chemotherapy it took to bring on remission
• whether you have a match for an allogeneic stem cell transplant (this means that your donor is a close, but not identical, genetic match, usually a first-degree relative)
• prognostic factors
• your age
• your overall health

The 2 basic treatment choices for consolidation are intensive chemotherapy or a stem cell transplant.

If you have intermediate or unfavourable-risk AML, your doctors may consider a stem cell transplant after your induction chemotherapy.

If you have a favourable-risk AML, you will likely not need a stem cell transplant. Instead you will have consolidation treatment with chemotherapy and maybe targeted therapy.

If you are elderly and not able to have intensive chemotherapy or a stem cell transplant, you may have less intensive consolidation treatment given for a longer time.

Chemotherapy uses anticancer drugs to destroy cancer cells. Chemotherapy is the main consolidation treatment for AML. Chemotherapy is given soon after remission has been reached (2 to 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 high-dose cytarabine (Cytosar) alone or combined with another chemotherapy or targeted therapy. High-dose cytarabine is given over 5 days and repeated every 4 weeks for 3 or 4 cycles.

Less intensive consolidation may be used to treat older people or people who aren't able to have intensive chemotherapy because of other health conditions.

Consolidation may include one of the following:

• high-dose cytarabine
• high-dose cytarabine with gemtuzumab ozogamicin (Mylotarg)
• cytarabine and daunorubicin (Cerubidine), idarubicin or mitoxantrone
• liposomal daunorubicin-cytarabine (Vyxeos)
• cytarabine, daunorubicin and targeted therapy

Find out more about chemotherapy for AML.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer.

If you received a targeted therapy drug during induction, you will likely continue to take it during consolidation.

• If you have AML with a mutation in the FLT3 gene, you may have targeted therapy drugs such as midostaurin (Rydapt).
• If you have AML with a CD33 protein marker, you may have targeted therapy drugs such as gemtuzumab ozogamicin.
• If you are older or not healthy enough to have intense chemotherapy, you may have targeted therapy drugs such as venetoclax or glasdegib.

Find out more about targeted therapy for AML.

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 usually given during a lumbar puncture. Find out more about chemotherapy for AML.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is sometimes given to the brain and spinal cord along with intrathecal chemotherapy. Find out more about radiation therapy for AML.

A stem cell transplant replaces stem cells. If you have intermediate or high-risk AML 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, there are other types of stem cell transplant that can be used.

Find out more about stem cell transplant for AML.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation therapy may be given as part of the conditioning treatment before a stem cell transplant. It may also be used to treat AML that has spread to the central nervous system.

Find out more about radiation therapy for AML.

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

Find out more about supportive therapy.

Talk to your doctor about clinical trials open to people with AML in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.