The goal of treating acute myeloid leukemia (AML) is to completely destroy the disease and stop the bone marrow from producing abnormal blood cells. Intensive chemotherapy is important to help your child get into remission.
The protocol for treating AML is divided into separate phases: a two-cycle induction phase followed by a three-cycle consolidation phase. Each phase differs in length and the type of medicines that are used.
Both of these phases include central nervous system (CNS)-directed therapy. This is chemotherapy that is given by the intrathecal (IT) route, through a lumbar puncture.
Some of the drugs listed for each treatment phase may differ from your child’s protocol. The treatment plan may differ depending on your child’s AML. For example, patients with high-risk AML require a bone marrow transplant, if feasible.
1. Induction phase
The aim of induction therapy is to destroy leukemic cells and get your child into remission. Your child is in remission when:
- Less than 5% of the bone marrow cells are cancerous,
- The bone marrow is producing a normal amount of white blood cells, red blood cells and platelets (small cells that help stop bleeding at sites of the body that are cut or injured).
Your child will undergo two cycles of induction therapy. Each cycle will last about 28 days.
Medicines taken during induction
During each cycle of induction, your child will take high doses of the following medicines:
- cytarabine (Ara-C)
- daunorubicin (DAUN)
- etoposide (VP-16)
While chemotherapy kills the leukemic cells, it can also affect the healthy cells inside your child’s bone marrow making them prone to infections and bleeding. For this reason, all children with AML stay in the hospital throughout most of their treatment. This way, the treatment team can provide the best supportive care.
To help reduce the risk of infection, your child may take preventative medicines, including:
- an antibiotic called cotrimoxazole (Septra®)
- an antifungal called fluconazole
How is your child’s response to treatment monitored?
The doctor checks how well the AML is responding to treatment by checking if the amount of leukemic cells inside your child’s bone marrow has decreased. This is checked at the end of your child’s first induction cycle and may be repeated if necessary.
2. Consolidation phase
Even when in complete remission, your child may still have some leukemic cells inside their bone marrow that doctors cannot see. For this reason, once your child has completed induction therapy, they continue more cycles of chemotherapy in a second consolidation phase. This phase is also important to prevent the disease from returning.
The is called the consolidation phase, or intensification.
Generally, doctors treat your child with three cycles of consolidation therapy. Each cycle lasts 28 days each.
During the first cycle of consolidation your child may take the following medicines:
- cytarabine (Ara-C)
- etoposide (VP-16)
During the second cycle of consolidation, your child may take the following medicines:
- cytarabine (Ara-C)
- mitoxantrone
During the third cycle of consolidation, your child may take the following medicines:
- cytarabine (Ara-C)
- asparaginase (ASP)
AML with Down syndrome
Children with Down syndrome who are diagnosed with AML follow a less intense treatment protocol. This is because they often respond well to chemotherapy, especially to cytarabine. The outcome of these children is usually much better than those diagnosed with AML who do not have Down syndrome.