1. Intensive Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. The drugs get into the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Or, it is given by a hematologist, a doctor who specializes in treating blood disorders.

Chemotherapy is the primary treatment for AML. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include:

__An intravenous (IV) tube placed into a vein using a needle. When chemotherapy is given by IV, it may be given into a larger vein or a smaller vein, such as in the arm. When it is given into a larger vein, a central venous catheter or port may need to be placed in the body.

__An injection into the cerebral spinal fluid
__In a pill or capsule that is swallowed (orally)
__An injection under the skin, called a subcutaneous injection

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given at the same time. Several drugs are used to treat AML, which are discussed below.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

2. Chemotherapy By Phase
Chemotherapy for AML can be divided into 3 phases: induction, post-remission, and consolidation.

Induction therapy. This is the first period of treatment after a person’s diagnosis. The goal of induction therapy is a complete remission (CR). A person has a CR when:
__Blood counts have returned to normal
__Leukemia cannot be found in a bone marrow sample when examined under the microscope
__There are no longer any signs and symptoms of AML

The combination of cytarabine (Cytosar-U) given over 4 to 7 days and an anthracycline drug, such as daunorubicin (Cerubidine) or idarubicin (Idamycin), given for 3 days is used most often. Patients may also be given hydoxyurea (Droxia, Hydrea) to help lower white blood cell counts. In addition to killing leukemia cells, these drugs also damage healthy cells, increasing the risk of infection and bleeding (see below). Most patients will need to stay in the hospital for 3 to 5 weeks during induction therapy before their blood counts return to normal. Sometimes, 2 rounds of therapy are needed to achieve a CR. Approximately 75% of younger adults with AML and about 50% of patients older than 60 achieve a CR after treatment.

Some older adults may not be able to have induction therapy with the standard drugs. The drugs decitabine (Dacogen), azacitidine (Vidaza), and low dose cytarabine may be used instead. A clinical trial is also an option.

Post-remission therapy. After induction therapy, a variety of different drugs are used to destroy AML cells that remain but cannot be detected by medical tests. AML will almost certainly recur if no further treatment is given after a CR. For some patients, bone marrow/stem cell transplantation (see below) is recommended as part of post-remission therapy.

Consolidation therapy. Chemotherapy or stem cell transplantation may be used for consolidation therapy.

Younger adults in remission are commonly given 2 to 4 rounds of high- or intermediate-dose cytarabine or other intensive chemotherapy at monthly intervals. Several different regimens are used for older patients. Although chemotherapy is usually given in the hospital, most of the recovery time can be spent at home.

A bone marrow/stem cell transplantation is often recommended as consolidation therapy for younger patients in whom cytogenetic or molecular studies predict a poorer prognosis with only chemotherapy.

Stem cell transplantation/bone marrow transplantation. A stem cell transplant is a medical procedure in which bone marrow that contains leukemia is destroyed and then replaced by highly specialized cells, called hematopoietic stem cells, that develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is the stem cells in the blood that are typically being transplanted, not the actual bone marrow tissue.

Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the type of leukemia, results of any previous treatment, and patient’s age and general health.

There are 2 types of stem cell transplantation depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). ALLO uses donated stem cells, while AUTO uses the patient’s own stem cells. ALLO transplants are generally used for AML.