Treating acute myeloid leukaemia

As acute leukaemia is an aggressive condition that develops rapidly, treatment will usually begin a few days after a diagnosis has been made.

Your treatment plan

Due to the often complex nature of acute leukaemia, the condition is usually treated by a team of different specialists working together. This type of team is known as a multidisciplinary team (MDT). See box, left.

Stages of treatment

Treatment for acute myeloid leukaemia is carried out in two stages:

• Induction – the aim of the initial stage of treatment is to kill the leukaemia cells in your bone marrow, restore your blood to proper working order and resolve any symptoms that you may have.
• Consolidation – this stage aims to kill any remaining leukaemia cells that may be present in your central nervous system.

Induction

The induction stage of treatment is carried out in hospital or in a specialist centre. This is because you will probably need to have regular blood transfusions as it is likely that your blood will not contain enough healthy blood cells.

You will also be vulnerable to infection, so it is important that you are in a sterile environment where your health can be carefully monitored and any infection that you have can be promptly treated. You may also be prescribed antibiotics to help prevent further infection.

Chemotherapy

You will be given a combination of chemotherapy medication to kill the leukaemia cells in your bone marrow. As you will need to have many medicines as part of your treatment, a tube will be inserted into a large vein near your heart. This is known as a central line. Having a central line means that you will not need to have many painful injections.

Some chemotherapy medication may also be directly administered into your cerebrospinal fluid in order to kill any leukaemia cells that may have spread to your nervous system. This is given using a needle that is placed into your spine, in a similar way to a lumbar puncture.

Side effects that occur following chemotherapy are common. They can include:

• nausea
• vomiting
• diarrhoea
• loss of appetite
• mouth ulcers
• tiredness
• skin rashes
• infertility
• hair loss

The side effects should resolve once treatment has finished. Your hair will usually take between three to six months to grow back.

All-trans retinoic acid (ATRA)

If you have the sub-type of acute myeloid leukaemia (AML) known as acute promyelocytic leukaemia, you will usually also be given a medicine called all-trans retinoic acid (ATRA). ATRA works by changing the immature blast cells into mature healthy blood cells.

Side effects of ATRA include:

• headaches
• dry mouth and skin
• nausea
• bone pain
• dry eyes

Depending on how well you respond to treatment, the induction phase can last from two weeks to several months. In some cases, you or your child may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve.

Consolidation

Leukaemia can return if just one cancerous cell remains in your body. Therefore the aim of consolidation treatment is to ensure that any remaining leukaemia cells are killed.

Treatment involves receiving regular injections of chemotherapy medication. This is usually done on an outpatient basis, which means that you will not have to stay in hospital overnight. However, you may require some short stays in hospital if your symptoms suddenly get worse or if you develop an infection.

The consolidation phase of treatment lasts several months.

Other treatments

There are a number of other treatments that are used in some circumstances. These are described below.

Dasatinib

Dasatinib is a new type of medication that is used to treat a sub-type of acute myeloid leukaemia, known as Philadelphia chromosome positive AML, when all other treatments have proved unsuccessful.

Dasatinib is a tyrosine kinase inhibitor. This means that it blocks a protein called tyrosine kinase that helps stimulate the growth of cancer cells.

Dasatinib cannot cure acute leukaemia but it can slow its growth, helping to relieve symptoms and prolong lifespan. Dasatinib is taken orally (in tablet form).

Common side effects of dasatinib include:

• diarrhoea
• headache
• rash or red, dry, itchy skin
• a build-up of fluids in the body, such as around your legs or face
• fatigue
• breathlessness
• nausea
• bone and muscle pain

Dasatinib can lead to a sudden drop in the number of blood cells. This means that you will become vulnerable to developing an infection and it is likely that you will bruise and bleed more easily.

See Acute leukaemia – Complications for more information and advice about vulnerability to infection and bleeding.

The National Institute for Health and Clinical Excellence (NICE) has not yet made a decision about whether the NHS should provide treatment with dasatinib for people with acute leukaemia. This means that it will be at the discretion of your local primary care trust (PCT) as to whether you will be offered dasatinib.

If you decide to pay for dasatinib on a private basis, the cost of a 14-week course of treatment is around £9,000. Your PCT may agree to fund some of this cost but, again, the decision is entirely at their discretion and they have no legal obligation to do so.

Radiotherapy

Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are two main reasons why radiotherapy is usually used to treat acute leukaemia:

• to treat advanced cases of AML that have spread to the nervous system and/or brain
• to prepare the body for a bone marrow transplant (see below)

Side effects of both types of radiotherapy include:

• hair loss
• nausea
• fatigue

The side effects should pass once your course of radiotherapy has been completed. However, your skin may be very sensitive to the effects of light for several months after the treatment has finished. If this is the case, avoid sunbathing or exposure to sources of artificial light, such as sunbeds, for several months.

Many younger children treated with radiotherapy will go on to have restricted physical growth during puberty.

A small number of people develop cataracts several years after radiotherapy. Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make your vision blurred or misty. Cataracts can usually be successfully treated using surgery.

See the Health A-Z topics about Cataracts and Cataract surgery for more information.

Bone marrow and stem cell transplants

If you or your child do not respond to chemotherapy, a possible alternative treatment option is bone marrow or stem cell transplantation.

Before transplantation can take place, the person receiving the transplant will need to have aggressive high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body. This can put an enormous amount strain on the body and cause significant side effects and potential complications.

Transplantations have better outcomes if the donor has the same tissue type as the person who is receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type.

Due to these issues, transplantations are usually only successful when they are carried out in children and young people, or older people who are in good health, and when there is a suitable donor, such as a brother or sister.