Major Acute Myeloid Leukemia Treatments

Acute myeloid leukemia is a type of cancer in which the bone marrow produces abnormal myeloblasts, red blood cells, or platelets. White blood cells become abnormal and block healthy blood development from within the bone marrow. Typically, individuals suffering from acute myeloid leukemia feel fatigued, bruise easily, experience shortness of breath, and start bleeding often for unknown reasons. The good news for patients with this form of cancer, however, is there are quite a few options when it comes to treatment.

Leukapheresis

Leukapheresis, a specific type of apheresis, is a procedure in which white blood cells are separated from other parts of the blood. When it comes to acute myeloid leukemia, a big part of the problem with the patient's blood is there are too many white blood cells being produced, which can sometimes cause blockages. The process of leukapheresis will remove the blood from a patient's body and scrub the white blood cells out of the blood and return the clean blood to the patient simultaneously. This type of treatment lowers the white blood cell count in the system right away, thus allowing other treatments to get a foothold.

Chemotherapy

The age and overall health of the patient with acute myeloid leukemia will dictate the type of chemotherapy used. Doctors now have various choices on how they will proceed with chemotherapy. Given the invasive nature of chemotherapy, the process will need to be completed in the hospital under the watchful eye of trained professionals. The hospital stay can be up to a week and during this time the patient normally feels very ill.

The goal of chemotherapy is to kill the abnormal cells, however, an unfortunate side effect is the destruction of most of the normal bone marrow. The challenge with achieving the desired outcome is extremely high doses of chemotherapy can damage the bone marrow beyond repair. The medical team will need to find the right chemotherapy balance to fight the patient's acute myeloid leukemia.

Blood Product Transfusion

A blood product is not synthetic blood, rather, it is different components that make up blood such as red blood cells, white blood cells, plasma, and platelets. Each one of these types of cells has a specific job and function. When going through treatment for acute myeloid leukemia, the doctor will determine which blood components best fit considering the patient's requirements. The doctor may also pair the transfusion with different rounds of antibiotic treatments as the patient's immune system will be greatly compromised and left with little defense. During the recovery stage, the patient's doctor may need to take various bone marrow biopsies to determine if the bone marrow is regenerating at a healthy level and all leukemia cells have dissipated.

Radiation Therapy

Radiation therapy is not typically used when treating acute myeloid leukemia, however, it can be used should the cancerous cells spread to the spinal fluid, brain, and possibly testicles. The type of radiation therapy considered most effective against acute myeloid leukemia is called external beam radiation. The process is similar to having x-rays taken. The procedure is introduced to reduce the tumor size prior to surgery or to prevent a recurrence of the tumor following surgery.

Stem Cell Transplant

Following chemotherapy or radiation therapy the doctor may choose to complete a stem cell transplant. The stem cells being used are 'blood-forming stem cells,' which can come from embryos or the bone marrow of adult donors. The objective of the transplant is for the stem cells to settle in the patient's bone marrow and over a period of several days, start to generate new bone marrow, replacing what has been damaged in the various processes of radiation and chemotherapy.

Targeted Therapy

Targeted therapy is a type of cancer treatment that uses drugs that work by targeting certain characteristics of cancer cells. There are several different targeted therapy drugs. FLT3 inhibitors are a targeted therapy drug able to treat individuals with leukemia cells containing a mutation in the FLT3 gene, which provides the instructions on how to produce the FLT3 protein that helps cancer cells grow and multiply. FLT3 inhibitors use this protein to target and kill leukemia cells. 

IDH inhibitors target leukemia cells with a mutation in the IDH1 or IDH2 gene, which contain the instructions for the production of IDH1 and IDH2 proteins. IDH inhibitors stop these proteins, which helps the leukemia cells differentiate into normal cells. Gemtuzumab ozogamicin is a form of targeted therapy that works by directing a certain chemotherapy drug to a protein found on leukemia cells. BCL-2 inhibitors target a protein present in leukemia cells that allows these cancerous cells to live longer than they normally would.

Surgical Intervention

Surgical intervention in the treatment of acute myeloid leukemia is limited to the placement of a central venous catheter and the removal of a myeloid sarcoma or isolated tumor of leukemia cells. Unlike other cancers that usually cause a malignant tumor to grow in a localized area, acute myeloid leukemia causes the growth and multiplication of cancerous cells in a patient's blood. Since these malignant cells are freely circulating throughout the body, they cannot be surgically removed the same way a cancerous tumor can.

In rare cases where a myeloid sarcoma develops, it can be removed with surgery. For patients who need to undergo chemotherapy for the treatment of acute myeloid leukemia, a central venous catheter will need to be placed. The surgical procedure for this involves the placement of a small flexible tube into a large vein located in the chest that exits the body just under the skin of the patient's upper arm or chest. Once in place, this catheter can be used for several months to provide direct access to the patient's bloodstream for drug administration.

Drug Therapy Other Than Chemotherapy

Drug therapy other than chemotherapy can be used to treat some patients who have a very specific form of acute myeloid leukemia, where leukemia cells cause uncontrollable blood clotting. The leukemia cells do so by releasing certain proteins into the bloodstream that influence blood clotting. This type of acute myeloid leukemia cannot be treated with traditional chemotherapy alone because once the leukemia cells are killed, the toxic proteins are released into the patient's bloodstream. 

To prevent the release of these proteins, treatment for these leukemia cells cannot cause cellular apoptosis or death without the proper preceding mediation. Instead, differentiation agents are drugs that work by helping the leukemia cells mature into healthy cells instead of killing them. Because these cells are not dying, they do not release the toxic proteins into the patient's blood. Even though differentiation agents do not work the same as chemotherapy, they can have adverse side effects of their own.

Phases Of Treatment

Acute myeloid leukemia treatment is broken up into phases. The first phase of treatment is called induction. During induction, the objective is to remove all leukemia cells from the blood and bone marrow with the use of intense drugs and chemotherapy. The next phase of treatment is called consolidation, where more chemotherapy is given to the patient once they have recovered from the induction phase. The objective of consolidation is to eliminate any leftover leukemia cells. The chemotherapy is administered in cycles with each block of treatment being followed by a period of rest to allow the patient's body to recover. 

The third phase of treatment for acute myeloid leukemia is called the maintenance or post-consolidation phase. The maintenance phase is not used for every type of acute myeloid leukemia. When it is used, it involves spread out cycles of low dose chemotherapy for several months or years after the completion of the consolidation phase.