Treatment of acute myeloid leukemia (AML) has improved dramatically over the past 30 years. To have the best chance of being cured, it is important for you to understand the treatments available and what is necessary to achieve the best results. When deciding whether to get treatment for AML, you should be aware of the goals of your therapy. Treatment may be given to increase the chance of a cure, to prolong life, or to improve symptoms. You and your doctor should carefully balance the potential benefits of receiving cancer treatment with the potential risks.

The following is a general overview of the treatment of AML. The exact type of treatment you receive will depend on your individual situation and your prognosis. The information on this website is intended to help educate you about your treatment options. It can help you when you make decisions with the cancer specialist who treats you.

Clinical Trials

Most new treatments are developed in clinical trials. These are studies that evaluate the safety and effectiveness of new drugs or treatments. Clinical trials make it possible to develop more effective cancer treatments.

If you take part in a clinical trial, you may get better treatments. You will also help to advance knowledge about treatment of AML. If you are interested in participating in a clinical trial, you should discuss the risks and benefits of taking part with your physician. In any case, you should stay informed by following the news about cancer trials. In this way, you can make sure that you are receiving the best treatment available.

Leukemia cells can become resistant to chemotherapy drugs. Because of this, doctors often give high doses of chemotherapy in a short time. This kills the leukemia cells before they have a chance to develop resistance.

Therapy is divided into two phases: remission induction and post-remission consolidation and maintenance. Induction chemotherapy is administered to produce a complete remission in the bone marrow. Remission is defined as less than 5 percent of leukemia cells remaining in the bone marrow and normal blood counts.

Specific treatment for AML will be based on:

• Your age, overall health, and medical history
• The extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Treatment may include:

• Chemotherapy
• Bone marrow transplantation
• Monoclonal antibodies (Mylotarg^® [gemtuzumab ozogamicin] used in conjunction with a chemotherapy drug)
• Radiation to treat leukemia in the brain or as a preparative regimen for transplant

To understand the best treatment options available for AML, you should know the classification or histologic subtype of the cancer. You should also know the results of your chromosome analysis, which are called cytogenetics. These tests are performed on a sample of your bone marrow.

Cytogenetics in Adult AML

The following table reports the outcomes of standard intensive chemotherapy in patients with different cytogenetic results. It shows how important it is to know your cytogenetic type.

Cytogenetics	Survival
Favorable: t(8, 21), t(15,17) and inversion 16	60%-80%
Intermediate: normal karyotypes (chromosomes)	40%
Unfavorable: all other clonal cytogenetic abnormalities	20%

As you can see, if you have unfavorable cytogenetic results, you need to consider therapies other than chemotherapy alone, for example allogeneic stem cell transplant once you are in first remission.

Cytogenetics in Childhood AML

Chromosome changes in leukemia cells are seen in 80 percent of children with AML. They are often associated with different treatment outcomes. With current treatment, 30 percent to 50 percent of children with AML are cured. It is important to identify those children who can be cured with standard treatments and those who should receive more individual treatment. The type of chromosomal abnormality present can help to identify patients with a "good" or "bad" outcome.

Molecular Monitoring of Minimal Residual Disease

The treatment of AML occurs in two phases. All AML subtypes are currently treated the same way except for acute promyelocytic leukemia (M3 subtype). Promyelocytic leukemia involves a shortage of mature blood cells and an excess of immature cells.

The first treatment phase is called remission induction. The goal of remission induction therapy is to achieve a complete remission, or disappearance, of all detectable leukemia cells.

The second phase of treatment is post-remission therapy. This phase begins after complete remission. Post-remission therapy is necessary because undetectable leukemia cells may still exist. If undetectable cells exist, the leukemia will return without additional therapy. Post-remission therapy is often referred to as consolidation.

Treatment decision varies by age. Younger patients (age less than 60 to 65) may be offered more intensive chemotherapy programs. However, these may not be well tolerated in older patients (over 65 or 70) who also may have other medical problems. Older patients may need to consider lower intensity investigational programs with new drugs.

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