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Overview
The treatment you have will depend on the subtype of acute myeloid leukaemia (AML), your age and overall health.
The main treatment for younger people is chemotherapy, which is sometimes followed by a stem cell transplant. Other treatments for AML are targeted therapy and radiation therapy.
A subtype of AML called acute promyelocytic leukaemia (APML) is treated differently, using 2 drugs called all-trans retinoic acid (ATRA) and arsenic trioxide.
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Treatment options for AML
Treatment will depend on the AML subtype, gene changes that have been found, and your overall health and age. In most cases, your doctor will need the results of genomic tests and immunophenotyping to work out the best treatment for you. It may take up to 2 weeks for these results to come through.
For younger people, chemotherapy is the main treatment. Older people are generally treated with a lower intensity therapy, including an oral targeted therapy drug called venetoclax. You may have other treatments depending on the subtype and how the AML responds to the drugs you are given.
Chemotherapy
Chemotherapy uses drugs to kill leukaemia cells or slow their growth. It's the main treatment for younger people with AML.
Stem cell transplant
A stem cell transplant is sometimes done after high-dose chemotherapy. It usually uses stem cells from another person (allogeneic transplant).
Targeted therapy
Targeted therapy uses drugs that attack specific features of leukaemia cells to stop the leukaemia growing and spreading.
Radiation therapy
Radiation therapy uses targeted radiation to kill or damage leukaemia cells so they cannot grow, multiply or spread.
Palliative treatment
Palliative treatment can be used at any stage of advanced AML to improve quality of life. It may include chemotherapy or radiation therapy.
Treatment for APML
Treatment for the subtype of AML known as acute promyelocytic leukaemia (APML) is different from most other AML treatments.
Induction phase
A drug called all-trans retinoic acid (ATRA) is the main type of induction treatment. ATRA is not a chemotherapy drug, but it may be given with chemotherapy.
ATRA makes immature promyelocyte cells mature, so they are no longer leukaemia cells. It is taken as a tablet (orally).
People with APML are also treated with arsenic trioxide. This is given daily, through a drip into a vein or through a central venous access device (CVAD).
Induction with ATRA and arsenic trioxide is usually given over 5–6 weeks. You will have regular echocardiography (ECG tracing of the heart) and blood tests to monitor your full blood count and the levels of minerals in the blood.
In most people with APML, treatment with ATRA and arsenic trioxide leads to remission. Some people with high white blood cell counts may also need to have intravenous chemotherapy.
Samples of your bone marrow will be tested for a gene change known as PML-RARA. This can help doctors work out whether you are in remission.
Consolidation phase
Further cycles of chemotherapy will be started 1–2 weeks after the induction phase ends. This phase, known as consolidation, may last for several months. It aims to destroy any cells that may have survived the induction phase and to stop APML returning (relapsing).
Side effects
Side effects of ATRA and arsenic trioxide may include headaches, bleeding and clotting problems, and nausea (feeling sick). During the induction phase, an uncommon but serious reaction known as APML differentiation syndrome can cause breathing difficulties, fever, weight gain and high blood pressure. Tell your treatment team if you experience any of these side effects.
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