NCCN Guidelines for Patients® | Acute Myeloid Leukemia

32 NCCN Guidelines for Patients ® : Acute Myeloid Leukemia, 2018 4  Treatment guide: Non-APL AML Overview This chapter is a treatment guide for all non-APL subtypes of AML. It starts with a brief overview of the treatment process. It also lists treatment options and explains supportive care. Your doctor may suggest other options based on your health and wishes. Fully discuss your options with your doctor. Overview There are many subtypes of AML. Most people with leukemia do not have APL. In the past, all non-APL subtypes were treated the same way. As doctors learn more, treatment is being improved to better target each subtype. Diagnosis Acute leukemia is defined by a high number of blasts in the bone marrow or blood. The standard cutoff is at least 20 out of every 100 marrow cells are blasts. If there are fewer blasts, then a common marker must be present. Subtypes of AML are based on features of the cells. The cause of AML is not always known. It can occur for no known reason. Other times, it is caused by certain treatments of other cancers. AML can also arise from MDS ( m yelo d ysplastic s yndromes). Treatment for AML is not based on what caused it. Treatment phases Treatment for AML can occur over years. It involves several phases. These phases are briefly described next. Induction This is the first phase of treatment. It is also called remission induction. It is standard to receive 2 to 4 chemotherapy drugs for 3 to 10 days. The treatment goal is to greatly reduce the number of blasts. As the blasts decrease, other types of marrow cells will decrease, too. The other treatment goal is to restore the process of making normal blood cells. Monitoring Blood samples will be needed often to check treatment results. Your blood counts will be measured. The health of organs like your liver and kidneys will also be assessed. Bone marrow samples will also be obtained. This typically occurs 2 to 3 weeks after the start of chemotherapy. Samples may be obtained 3 to 4 months after some low-intensity treatments. Marrow tests will show how well treatment worked. If too many blasts are present, marrow tests may be repeated. If the blasts persist, you may receive more treatment. This extra treatment is sometimes called re-induction. After more induction, the blasts may persist. In this case, treatment options will include those for relapse. These options are described below. If blasts are absent in marrow, no treatment will be given for 2 to 4 week. During this time, your marrow will begin to make normal blood cells again. This is called recovery. When blood counts become normal, marrow tests will be done again. Your doctor will check if the leukemia is in remission. A complete remission is an absence of all signs and symptoms. Consolidation This is the second phase of treatment. It is also called post-remission therapy. It treats blasts that may have survived induction. You may receive the same drugs used for induction. If not, you may receive one drug at a higher dose. A blood stem cell transplant may also be an option. It