Acute Myelogenous Leukemia and Chemotherapy
The standard of care for newly diagnosed patients is chemotherapy, which currently is the only treatment capable of producing complete remission in substantial numbers of patients.
Chemotherapy treatment uses chemical agents to kill leukemia cells. Depending on the type of leukemia, the patient may receive a single drug or a combination of one or more drugs. These drugs may come in a pill form, or they may be injected directly into a vein
Chemotherapy for AML is given in two phases: remission induction and post-remission therapy.
Commonly Used Chemotherapy Drugs
CHEMOBRAIN: A Once Misunderstood And Misdiagnosed Phenomenon
Remission Induction Therapy
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Chemotherapy is typically administered for 3-7 days
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Chemotherapy reduces both the number of normal and leukemic blasts. (a “blast” is an immature cell located in the marrow and blood). Such reduction usually lasts 4-5 weeks.
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Complete remission indicates that 99.9% of the cancer cells (leukemic blasts) have been destroyed. However, there are still often some “hidden” leukemic cells that remain in the body that can subsequently lead to relapse.
Post-Remission Therapy
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Chemotherapy is typically administered for 3-7 days.
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Goal is to destroy the remaining leukemic cells.
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Usually several cycles of chemotherapy are given.
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Each chemotherapy cycle lasts several days following which blood counts fall, returning to normal 4-6 weeks later at which time another cycle of chemotherapy begins.
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Typically 4-6 post-remission therapy cycles are given. The doses of chemotherapy given in the post-remission phase are often lower than those used initially for the remission induction phase of treatment.
Chemotherapy Risks
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The low blood counts associated with chemotherapy predispose patients to potentially fatal infections. Infections are, by far, more common during the induction phase, because the patient is not yet in complete remission and/or the doses of chemotherapy during induction are higher than the chemotherapy doses during remission.
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Side effects includes nausea, tiredness and higher risk of infections.
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The likelihood of fatal infection increases with age, and approaches 30% in patients age 70 and over.
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Another important predictor of death associated with induction chemotherapy is whether the patient is ambulatory when chemotherapy begins; about 15% of patients are not fully ambulatory at this time and as a result have a much higher complication rate.
Commonly Used Chemotherapy Drugs
Some of the commonly used chemotherapeutic drugs include:
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Anthracyclines also known as daunorubicin or idarubicin (Daunomycin, Idamiycin)
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Aclarubicin
Choice of chemotherapeutic agents depends upon the type of AML diagnosed.
Remission rates average 60%, with 10-20% of patients remaining in remission at 3 years. Remission and cure rates vary significantly with age, performance status, and, particularly cytogenetic status.
Use of cytogenetic information is crucial in planning therapy
Click here for a list of clinical trials offered for chemotherapy nationwide.
Click here for a list of treatment centers.
Sources
* MediFocus Guide from Medifocus.com, Inc.
* National Marrow Donor Program, www.marrow.org
* Cancer Care Consults, www.cancerconsultants.com