Acute Myeloid Leukemia - The Leukemia & Lymphoma Society

More documents

Recommendations

Info

Table 3. Some Drugs Used to Treat Acute Myeloid LeukemiaMost antileukemic drugs interact with the cell’s genetic material (the DNA).Anthracyclines (Antitumor Antibiotics)◦{daunorubicin (Cerubidine®)◦{doxorubicin (Adriamycin®)◦{idarubicin (Idamycin®)◦{mitoxantrone (Novantrone®)Antimetabolites◦{cladribine (2-CdA; Leustatin®)◦{clofarabine (Clolar®)◦{cytarabine (cytosine arabinoside, ara-C; Cytosar-U®)◦{fludarabine (Fludara®)◦{hydroxyurea (Hydrea®)◦{methotrexate◦{6-mercaptopurine (Purinethol®)◦{6-thioguanine (Thioguanine Tabloid®)Topoisomerase Inhibitors◦{etoposide (VP-16; VePesid®, Etopophos®)◦{topotecan (Hycamtin®)DNA Damaging (Alkylating) Agents◦{cyclophosphamide (Cytoxan®)◦{carboplatin (Paraplatin®)◦{temozolomide (Temodar®)Cell-Maturing Agents◦{all-trans retinoic acid (ATRA, tretinoin; Vesanoid®)◦{arsenic trioxide (Trisenox®)Hypomethylating Agents◦{azacitidine (Vidaza®)◦{decitabine (Dacogen®)Table 3. I This table lists some of the standard drugs and some of the drugs under study in clinical trials to treatAML patients. Various approaches to AML treatment are undergoing study in clinical trials. A patient may betreated with drugs that are not listed in this table and still be receiving appropriate and effective treatment. Fora description of standard chemotherapy combinations, see page 15. It is essential to seek treatment in a centerwhere doctors are experienced in the care of patients with acute leukemia.page 16 I 800.955.4572 I www.LLS.org
Postremission Therapy. Normal blood cell production will return in manypatients several weeks after initial treatment is completed. Blood cell countsgradually approach normal, well-being returns and any remaining AML cells cannotbe detected in blood or marrow. This is called a “remission.” A small number ofresidual AML cells will not interfere with normal blood cell development, but thenumber of cells has the potential to grow and cause a relapse of the AML.Postremission therapy, also called “consolidation therapy,” is needed to killremaining AML cells and prevent relapse. Some of the main factors that influencethe approach used include◦{Patient age◦{Ability to tolerate intensive treatment◦{Cytogenetic and molecular characteristics of the AML cells◦{Availability of an HLA-matched related or unrelated stem cell donor.AML postremission treatment consists of additional intensive chemotherapy afterremission has been achieved, with or without autologous or allogeneic stem celltransplantation. Patients are hospitalized for postremission therapy. The length ofstay varies depending on the treatment and other factors.Patients who do not have a transplant generally are given four cycles ofchemotherapy. If chemotherapy alone is used, the best results occur if intensivetreatment is applied. Intensive chemotherapy can be given with high dosages ofcytarabine or other drugs.Some patients may benefit from intensive chemotherapy alone followed by one ofthree types of stem cell transplantation:◦{Autologous◦{Allogeneic◦{Reduced-intensity allogeneic (under study in clinical trials).The question of which patients are likely to benefit from transplantation after theirfirst complete remission is under study in clinical trials. Studies show that allogeneicstem cell transplantation may benefit poor- and intermediate-risk patients whoare younger than 60 and have a sibling match. There does not seem to be anyclear advantage for patients considered favorable or chemo-sensitive. Autologoustransplant is being used in some centers as an alternative to multiple cycles ofchemotherapy. Treating with a reduced-intensity transplant has shown some benefitfor healthier older patients, up to age 75.Clinical trials are examining several different approaches: modulating the activityof the immune system (e.g. vaccines or cytokines) or giving new drugs that differfrom standard chemotherapy (e.g. tipifarnib [Zarnestra®], sorafenib [Nexavar®],Acute Myeloid Leukemia I page 17
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 and 16: Table 2. Some AML Risk FactorsCerta
Page 17: Talk to yourdoctor aboutYour treatm
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?