Chemotherapy for acute myeloid leukaemia (AML)

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy or damage leukaemia cells. These drugs affect with the way leukaemia cells grow and divide.

The aim of induction treatment is to quickly get rid of the leukaemia cells. This allows your bone marrow to work normally again. This is called remission. You usually need to stay in hospital during treatment and possibly for a few weeks after until your blood cells recover.

You will need a lot of support from nursing and medical staff. They will monitor you closely for side effects, such as infection. You may need blood or platelet transfusions because your blood cell count will be low for a few weeks. You may also need antibiotics and antiviral drugs to prevent or treat infection. This is called supportive therapy.

You may need 1 or 2 cycles of induction treatment. A cycle of treatment usually lasts about 10 days. You may be able to go home between treatments. You usually have a combination of 2 or 3 drugs. Induction chemotherapy usually includes:

• cytarabine
• daunorubicin.

Sometimes you have cytarabine along with another chemotherapy drug called fludarabine (Fludara^®).

Depending on the results of tests on the leukaemia cells, you may also have targeted therapy drugs.

You may have a chemotherapy drug called liposomal cytarabine–daunorubicin (Vyxeos^®) if:

• AML is linked to previous cancer treatment or to myelodysplastic syndrome (MDS)
• the leukaemia cells have certain genetic changes.

After chemotherapy, your marrow and blood cells start to recover. You will have a bone marrow biopsy and blood tests to check whether you are in remission. If tests show very small numbers of leukaemia cells (minimal residual disease) or none, your doctor will say you are in remission.

You usually have consolidation treatment after 2 cycles of induction, if you are in remission. It aims to get rid of any remaining leukaemia cells and prevent the leukaemia coming back. It starts when your blood cell count is normal. You may have consolidation treatment as an outpatient. You have it for a few months.

The most common drug used in this phase is high-dose cytarabine (HiDAC). You usually have it on its own or sometimes with other chemotherapy drugs.

Some people go on to have a stem cell transplant after 1 or 2 cycles of chemotherapy. This is usually a donor (allogeneic) transplant, but it may be from your own cells (autologous). Your doctor will tell you more about whether this is suitable for you.

Chemotherapy can cause side effects. Your doctor, nurse or pharmacist will explain what to expect. This depends on the intensity of your treatment and the drugs you have. Different drugs cause different side effects. They will explain how side effects can be controlled or managed. They will also talk to you about the risk of possible late effects.

Your doctors and nurses will monitor you carefully. It is important Always to tell them about any side effects you have.

We have more information about the side effects of chemotherapy.