Treatment

The aim of treatment for acute myeloid leukaemia is to destroy the leukaemia cells and allow the bone marrow to work normally again. When there is no sign of the leukaemia it is known as remission.

Types of treatment

Chemotherapy is the main treatment used, as research has shown that certain types of chemotherapy drugs can be very effective in treating AML. Most patients with acute myeloid leukaemia go into remission after chemotherapy and more and more people are being cured.

People who have promyelocytic AML (type M3) will also be treated with a drug called ATRA (all trans-retinoic acid). It is a specialised form of vitamin A and is also known as tretinoin (Vesanoid(r)). ATRA is given for up to three months alongside chemotherapy treatment as it makes the leukaemic cells mature (differentiate) and so can reduce the leukaemic symptoms very quickly. See page 29 for more information about ATRA.

Your doctor will plan your treatment by taking into account a number of things, including your age, general health, and the type of genetic abnormality present in the leukaemia cells.

Some people have a greater risk of the leukaemia not going into remission or of coming back after treatment. This is known as high-risk AML. Factors which make the leukaemia less likely to respond to treatment, or to come back, include:

• being over 60 years of age
• having a very high number of abnormal white blood cells
• particular types of genetic changes (chromosomal changes).

The treatment for people with ‘high-risk leukaemia’ may vary slightly from people who do not have these factors. A research trial (AML-HR) is currently being carried out to test new types of treatment against the standard treatments for high-risk AML and your doctor may ask you whether you want to enter the trial.

People over 60 with AML may be asked to consider taking part in a research trial to see whether more intensive chemotherapy is more effective in treating the leukaemia than less intensive chemotherapy. The trial is known as AML-14.

Many people who are under 60 with AML may be asked if they would like to take part in the AML-15 trial, which is comparing the effectiveness of the current treatments used for AML.

You will be given detailed information about any trial in which you are invited to take part.

The main treatment for AML is chemotherapy. Some people may also go on to have high-dose chemotherapy with a stem cell or bone marrow transplant

You may find that other people with leukaemia at the hospital are having different treatment from you. This may be because their illness takes a different form, so they have different needs. If you have any questions about your own treatment, don’t be afraid to ask your doctor or nurse. It is often useful to make a list of questions for your doctor and to take a close friend or relative with you.

Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be pleased to refer you to another specialist for a second opinion, if you feel this will be helpful. However, this can sometimes take time to arrange and may mean that the start of your treatment is delayed, which may not be advisable. Usually treatment for AML should be started as soon as possible.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Treatments for leukaemia can be complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it. If AML is not treated, people usually live only for a few weeks.

It is important to tell a doctor, or the nurse in charge, about your decision immediately so that your decision can be recorded in your medical notes.

The benefits and disadvantages of treatment

Many people are frightened at the prospect of cancer treatments, particularly because of the potential side effects. Some people ask what would happen if they did not have any treatment.

Although many of the treatments can cause side effects, knowledge about how these treatments affect people and improved ways of reducing or avoiding many of these problems, have made most of the treatments much easier to cope with.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. In people with AML, chemotherapy is usually done with the aim of curing the cancer. Occasionally additional treatments, such as high-dose chemotherapy with stem cell or bone marrow transplants, are also given to reduce the risks of it coming back.

If the leukaemia has returned after initial treatment, more treatment may be given to get the leukaemia into remission again.

If the leukaemia is at a more advanced stage, the treatment may only be able to control the disease, leading to an improvement in symptoms and a better quality of life. However, for some people in this situation the treatment will have no effect upon the leukaemia and they will have the side effects without any of the benefit.

If you have been offered treatment that is intended to cure the leukaemia, the decision whether to accept treatment may not be a difficult one. However, if a cure is not possible and the treatment is being given to control the leukaemia for a period of time, it may be more difficult to decide whether to go ahead with treatment or not.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms.