Acute Myeloid Leukemia - The Leukemia & Lymphoma Society

More documents

Recommendations

Info

High White Cell Count. About 5 percent of AML patients develop signs orsymptoms attributable to a very high blood blast cell count. A white cell countgreater than 100,000 at the time of diagnosis is associated with unfavorable risk.Fast Facts About AML Treatment◦{For some patients, AML is curable with current therapies.◦{A person who has AML should (or must) be evaluated and treated by ahematologist or an oncologist.◦{It is essential to seek treatment in a center where doctors are experienced inthe care of patients with acute leukemia.◦{Many patients with AML, particularly those with high white blood cellcounts, need treatment as soon as possible after diagnosis. The approachfor treating each patient is based on an individual’s subtype, risk factors andtreatment goals.◦{Achieving a remission is important because it is associated with prolongingsurvival. The initial goal of treatment is usually to bring about a remission,in which◦ { There is no evidence of leukemic blast cells in the blood or marrow.◦{Normal blood cell production is restored and blood cell counts return tonormal levels.◦{Variations on standard approaches to treatment are undergoing intensivestudy throughout the world. A patient may receive a different numberof drugs, a different sequence of drugs, or drugs different from thosedescribed in this booklet, and still be receiving appropriate and effectivetreatment.◦{In most patients, intensive chemotherapy is required to achieve completeremission. At least two drugs are combined to treat patients initially.◦{More treatment is needed once a remission is achieved to help preventa relapse.◦{Postremission treatment may consist of chemotherapy, stem celltransplantation or low-dose maintenance chemotherapy.◦{If relapse occurs, treatment options may include different chemotherapyregimens, allogeneic stem cell transplantation or other investigationaltherapies.◦{For older AML patients, age alone is not a contraindication to treatment.Fit patients in their 70s and 80s can enter remission.◦{Patients who have the M3 subtype, acute promyelocytic leukemia (APL),are treated with all-trans retinoic acid, arsenic trioxide and an anthracycline(see page 20).page 14 I 800.955.4572 I www.LLS.org
Talk to yourdoctor aboutYour treatment options and the results you can expectfrom treatment. It is important to be informed about theresults you might expect with standard therapy and todiscuss the possibility of participating in a clinical trial.Chemotherapy. The initial phase of chemotherapy is called “induction therapy.”Induction may involve the simultaneous use of multiple drugs or a planned sequenceof treatments. For most AML subtypes, patients are treated with an anthracycline,such as daunorubicin, doxorubicin or idarubicin, combined with cytarabine (alsocalled “cytosine arabinoside” or “ara-C”). Other drugs may be added or substitutedfor higher-risk, refractory or relapsed patients. Autologous or allogeneic stem celltransplantation may be added to the treatment plan for patients with relapsed AMLor patients at high risk of relapse after chemotherapy (see page 18).The anthracycline and cytarabine act in different ways to stop AML cell growthand lead to AML cell death. The anthracycline is usually given in the first 3 daysof treatment. Cytarabine is started at the same time but is given for 7 to 10 daysof treatment. This treatment is also called “7 plus 3.” Both drugs are dissolvedin fluids and given to the patient via an indwelling catheter (central line) orport. While “7 plus 3” is considered to be a standard, there are several clinicaltrials looking at ways to improve both the rate and duration of remission byadding specific molecularly-targeted drugs, increasing the doses of cytarabineand/or anthracyclines, or using a new drug that combines the cytarabineand anthracycline in a very specific ratio and delivers them together in anencapsulated form.The central line is placed surgically in a vein in the upper chest. The catheter istunneled under the skin of the chest so that it stays firmly in place. The external endof the port can be used to administer medications, fluids or blood products, or towithdraw blood samples for cell counts and chemical tests. See the free LLS bookletUnderstanding Drug Therapy and Managing Side Effects for additional informationabout drug administration.Typically, the severity of the disease and the side effects of this initial therapy resultin an initial hospital stay of 4 to 6 weeks. Some patients who live with a caregiverand near the medical facility may be safely discharged sooner. This depends on thepolicies of the treatment center and the status of the patient.The goal of induction therapy is to rid the blood and marrow of visible leukemicblast cells. Generally, if blast cells are still evident after the first course of inductionchemotherapy, a second course of the same chemotherapy is given. Table 3, onpage 16, lists some of the standard drugs used to treat AML patients, as well assome of the drugs under study in AML clinical trials. Please check www.LLS.org orcall our Information Specialists at (800) 955-4572 for updates to this information.Acute Myeloid Leukemia I page 15
Page 2: A Message From John WalterPresident
Page 5 and 6: LLS Has Ways to Help. Treatment for
Page 7 and 8: Depression. Treatment for depressio
Page 9 and 10: AML may develop from the progressio
Page 11 and 12: DiagnosisAn accurate diagnosis of t
Page 13 and 14: Other Tests. “Karyotyping” and
Page 15: Table 2. Some AML Risk FactorsCerta
Page 19 and 20: Postremission Therapy. Normal blood
Page 21 and 22: ill to have an allogeneic stem cell
Page 23 and 24: All-trans retinoic acid (ATRA), a v
Page 25 and 26: Children who have AML are treated w
Page 27 and 28: Other Side Effects. Chemotherapy af
Page 29 and 30: Treatment Outcomes. Patients with A
Page 31 and 32: Research and Clinical TrialsThe pro
Page 33 and 34: Normal Blood and MarrowBlood is com
Page 35 and 36: Medical TermsAbsolute Neutrophil Co
Page 37 and 38: abnormalities in cancer cells. No s
Page 40 and 41: Colony-Stimulating Factor. See Grow
Page 42 and 43: Extramedullary Myeloblastoma. See C
Page 44 and 45: Hematologist. A medical doctor who
Page 46 and 47: Inversion. An abnormality of chromo
Page 48 and 49: somatic mutations, leading to the f
Page 50 and 51: of one blood cancer cell among 500,
Page 52 and 53: Stem Cells. Primitive cells in marr
Page 54 and 55: Howlader N, Noone AM, Krapcho M, Ne
Page 56: For more information, please contac

Acute Myeloid Leukemia - The Leukemia & Lymphoma Society

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?