Acute myeloid leukaemia: Teenagers and young adults

Acute myeloid leukaemia: Teenagers and young adults

Treating AML

• Introduction
• Leukaemia, blood tests and bone marrow
• Tests for AML
• Treating AML

The main treatment for acute myeloid leukaemia (AML) is chemotherapy. This means having anti-cancer drugs to destroy the leukaemia cells. You’ll also have drugs called steroids, which help the chemotherapy to work.

The treatment for AML is pretty intensive at times and can cause unpleasant side effects. But you’ll be in hospital when you’re most likely to feel unwell, and the staff can help if things get tough. Don’t feel you have to be brave. Be honest about how you’re feeling with your doctors and nurses. They can give you medicines to help you feel better.

There are different phases of treatment for AML:

• getting rid of the leukaemia – remission induction
• keeping the leukaemia away – consolidation and delayed intensification therapy
• central nervous system (CNS) therapy (mainly for teenagers under 16)

Very often, treatment is given as part of a clinical trial or research study, but it will be your decision whether to take part in the trial or not. Clinical trials help doctors to keep improving treatment for leukaemia.  

You usually start chemotherapy pretty quickly after finding out that you have AML.

You’ll be in hospital for your treatment to begin with. If you’re 18 or younger, you’ll be treated in a specialist Principal Treatment Centre (PTC) for teenage and young adults (TYA). If you’re 19 or older, you’ll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital.

Most chemotherapy for AML is given into the bloodstream (intravenously). So you’ll have a ‘line’ put into one of your main veins to make it easier for you to have intravenous chemotherapy. There are different kinds of lines.

You’ll also be given chemotherapy into the fluid around your spinal cord and brain. This is to get rid of any leukaemia cells that might be hiding there. This type of treatment is called central nervous system (CNS) therapy.

Having chemotherapy can be hard, but the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And you’ll be given medicines to help you feel less sick and antibiotics to help prevent infections.

There will probably be times when you feel rough and other times when you’ll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings.

Being in hospital for long periods can be frustrating, especially when you miss out on stuff happening at school, college, university or work or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you.

Getting rid of the leukaemia (remission induction)

The first phase of your treatment is about getting rid of the leukaemia. You’ll be given chemotherapy to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow.

You have chemotherapy over a few days, then you have a few weeks off so that your body can recover from any side effects. The days you have the chemotherapy and the rest period afterwards is called a cycle. You’ll usually have 4 cycles of chemotherapy overall with 2 courses in the induction phase. Some people might also need to have a bone marrow transplant. This normally happens after 2 cycles of chemotherapy.

You’ll probably need to stay in hospital most of the time that you’re having remission induction. This is so that the doctors can check how things are going.

Chemotherapy drugs

Drugs you may have include:

• cytarabine (Ara-C)
• daunorubicin, doxorubicin or idarubicin
• etoposide
• thioguanine

Side effects

Different chemotherapy can cause different side effects. There is information about the specific ones in Macmillan’s chemotherapy section.

As well as the chemotherapy drugs, you’ll be given other drugs to:

• help prevent you from feeling sick or being sick
• help prevent infections
• protect your kidneys as sometimes when lots of leukaemia cells are destroyed at once it can cause kidney problems

You’ll probably also need blood and platelet transfusions to top up the numbers of red cells and platelets in your blood.

Chemotherapy can cause side effects. Most of them are short-term (temporary) and gradually disappear once treatment stops. The most common side effects are:

• being more at risk of infections
• feeling sick
• hair loss
• a sore mouth

Sometimes side effects can be long-term. For example, some chemotherapy treatments can affect fertility (your ability to have a baby). If you are a young man, you will be offered the chance to store sperm before chemotherapy is started. There may be other late effects of treatment and your specialist can talk to you about this.

Remission induction is pretty intense treatment and you’ll probably feel a bit wiped out sometimes. You’ll need to stay in hospital for most of the time and you might not have the energy to do much. You might feel fed up, tearful or irritable. It’s normal to feel like this. It’s hard to be in hospital and you might worry about losing touch with your friends or falling behind at school or college. It can help to talk about this with a friend, doctor, nurse or counsellor.

Keeping the leukaemia away (post-remission treatment)

This phase of treatment is sometimes also called consolidation or intensification treatment. It’s given to prevent the leukaemia from returning (known as a relapse).

When you’re in remission, it means the doctors can’t see any leukaemia cells in your blood or bone marrow samples under the microscope. But there may still be leukaemia cells hiding in your body, so further treatment is needed to get rid of these cells.

You start post-remission treatment soon after you complete remission induction. You’ll usually have 2 courses of treatment. You might be given the same chemotherapy drugs you’ve had before (perhaps at similar or higher doses) or you might be given different chemotherapy drugs.

When your doctors decide what chemotherapy treatment plan to give you, they will take into account:

• how well your leukaemia responded to the first lot of treatment (remission induction)
• the results of the tests that were done when you were diagnosed

The following drugs may be used to treat you:

• cytarabine (ara-C)
• methotrexate

Central nervous system therapy (CNS)

You usually won’t need this treatment if you’re 16 or over. But if you’re under 16, you’ll probably have it.

CNS therapy is given to get rid of any leukaemia cells that might be in the brain or spinal cord. (The CNS or central nervous system is the name for the brain and spinal cord.)

CNS therapy involves giving chemotherapy into the fluid, called cerebrospinal fluid or CSF, around the spinal cord and brain.

It’s a bit like having a lumbar puncture but with chemotherapy added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then they inject chemotherapy into the CSF. The CSF will carry the chemotherapy around your CNS so it can reach any leukaemia cells that might be there.

You’ll have a lumbar puncture before you start treatment to check for leukaemia cells in the CSF.

If there is no sign of leukaemia cells, you’ll have 2 lots of CNS therapy, 1 after each cycle of remission induction therapy.

If there are leukaemia cells in the CSF, you’ll have CNS therapy twice a week until all traces of leukaemia cells in your CSF have gone. You’ll then have 2 more lots of CNS therapy just to make sure.

For CNS therapy for AML, you’ll have chemotherapy drugs called methotrexate and cytarabine and a steroid called hydrocortisone.

Side effects

The most common side effect is feeling sick but you can be given anti-sickness treatment to help this. Rarer side effects include a headache, dizziness, tiredness or blurry vision for a few hours afterwards.

We also have more information about:

• symptoms and causes of AML 
• having tests for AML 
• leukaemia, blood cells and bone marrow

If you’re looking for information about AML in people of all ages, read our general AML section.