Which of the following is not commonly found in acute myelogenous leukemias?

Specific therapeutic procedures and interventions may vary, depending upon numerous factors, such as disease stage; specific genetic alterations present and specific AML subtype; the presence or absence of certain symptoms; whether leukemia has spread outside of the blood and bone marrow and what specific organ systems are involved; an individual’s age and general health; a person’s physical ability, ability to care for oneself, and ability to perform normal, daily activities (performance status); and/or other elements. Decisions concerning the use of specific drug regimens and/or other treatments should be made by physicians and other members of the health care team in careful consultation with the patient based upon the specifics of his or her case; a thorough discussion of the potential benefits and risks, including possible side effects and long-term effects; patient preference; and other appropriate factors. Doctors may use these factors to establish a classification or stratification of risk for a person with AML to offer a prognosis and to best guide treatment.

For most people, the initial treatment for AML is induction therapy. The goal of induction therapy is to achieve a complete remission of the disease. This involves the use of chemotherapy, a combination of drugs that are harmful to cancerous cells and tissue. Chemotherapy can reduce the number of cancerous cells in the body and prevent new cells from forming. For young adults (i.e. under 60 years of age), an anthracycline chemotherapy drug like daunorubicin or idarubicin in combination with cytarabine, is usually used and may be referred to as the “7 + 3 regimen” (7 days of therapy with cytarabine, plus 3 days of an anthracycline drug). There are other options as well including regimens with higher doses of cytarabine. These different options need to be discussed in detail with a patient’s physician and medical team. Induction therapy has very high success rates in achieving remission, but there are also high rates of cancer coming back, called a relapse. Induction therapy is a highly toxic treatment regimen and requires close monitoring.

It is common for a small number of leukemic cells to remain after induction therapy. This may be referred to as minimal residual disease. Consequently, after induction therapy, individuals may undergo a second phase of treatment, called the consolidation phase or postinduction therapy. This is done after a person has had time to recover from the side effects of induction therapy, and is performed to destroy any cancerous cells that remain and achieve long-term remission. In general, consolidation therapy consists of more chemotherapy or an allogeneic stem cell transplant.

Consolidation phase chemotherapy may consist of another round of the chemotherapy regimen used in induction therapy, different doses of drugs used in the initial induction therapy, or treatment with different drugs. For instance, higher doses of cytarabine either alone or in combination with other drugs are often used. One such combination is the FLAG-IDA regimen (cytarabine, fludarabine, granulocyte colony stimulating factor and idarubicin). New chemotherapy drugs and new regimens (combinations of drugs) are being studied in clinical trials. A physician may recommend that a person with AML join a clinical trial, especially if their disease seems resistant to standard treatment options.

Sometimes, doctors may recommend an allogeneic stem cell transplant for consolidation therapy. Whether to undergo this procedure is based on many factors including those discussed in the second paragraph of this section. An allogeneic stem cell transplant is a type of bone marrow transplant. Hematopoietic stem cells are special cells found in bone marrow that manufacture different types of blood cells (e.g., red blood cells, white blood cells, platelets). In allogeneic stem cell transplantation, stem cells are donated from another person, usually from a closely matched family member. In people with AML, this procedure follows treatment with strong doses of chemotherapy to wipe out leukemic cells. Sometimes, radiation therapy may also be used. In some people, the new (donated) cells that are infused into the patient will recognize any remaining leukemic cells as foreign and destroy them. This is called graft-versus-leukemia effect, but it does not always occur. Allogeneic stem cell transplants can be associated with severe, even life-threatening complications. Generally, this therapy is reserved for people who do not respond to other treatment options and younger patients who meet specific criteria.

Some people such as certain older individuals who meet specific criteria may elect to undergo a reduced-intensity (nonmyeloablative) allogeneic stem cell transplant. These transplants involve an initial chemotherapy regimen given at lower doses (reduced intensity), and thus are mild enough for people who are not eligible for a regular allogeneic stem cell transplant.

In 2017, the following drugs were approved to treat AML:

Midostaurin (Rydapt) was approved for the treatment of adult patients with newly diagnosed FLT3 gene positive AML in combination with standard cytarabine and daunorubicin induction and cytarabine consolidation. Rydapt is manufactured by Novartis Pharmaceuticals Corp.

Idhifa (enasidenib) was approved to treat adult patients with relapsed or refractory AML who have a IDH2 gene mutation. The drug was approved for use with the RealTime IDH2 Assay, which is used to detect specific mutations in the IDH2 gene in patients with AML. Idhifa is manufactured by the Celgene Corporation. The RealTime IDH2 Assay is manufactured by Abbott Laboratories.

Vyxeos was approved to treat adults with two types of AML: newly diagnosed therapy-related AML (t-AML) and AML with myelodysplasia-related changes (AML-MRC). Vyxeos is a fixed-combination of chemotherapy drugs daunorubicin and cytarabine that is manufactured by Jazz Pharmaceuticals.

Mylotarg (gemtuzumab ozogamicin) was approved to treat adults with newly diagnosed AML whose tumors express the CD33 antigen (CD33-positive AML) and to treat patients aged 2 years and older with CD33-positive AML who have experienced a relapse or who have not responded to initial treatment. Mylotarg is manufactured by Pfizer Inc.

In 2018, Tibsovo (ivosidenib) was approved to treat adult patients with relapsed or refractory AML who have a specific genetic mutation. This is the first drug in its class (IDH1 inhibitors) and is approved for use with an FDA-approved companion diagnostic test used to detect specific mutations in the IDH1 gene in patients with AML. Tibsovo is manufactured by Agios Pharmaceuticals, Inc. The companion diagnostic test is made by Abbott Laboratories.

More than 50% of people with AML experience a return of cancer, called a relapse. If relapse occurs within the first year, then physicians may recommend that individuals participate in a clinical trial for a new treatment option. Another option is to try another round of induction therapy with a different chemotherapy regimen and new drugs. If a relapse is over a year later, then physicians may recommend an allogeneic stem cell transplant, or they may recommend repeating the chemotherapy used during induction therapy, or they may recommend both. People who experience a relapse or for whom further treatment is ineffective, may be encouraged to participate in a clinical trial.

There is no clear age that distinguishes between younger adult and older adult. In most studies, older adults have been defined as people over the age of 60. Treatment for older adults is difficult because they are more likely to have conditions unrelated to AML (e.g. heart disease, diabetes) that may limit treatment options. AML also tends to be more resistant to chemotherapy in older adults and they are more susceptible to side effects from treatment. There is no agreed upon, optimal approach to treating older adults with AML. Treatment for older adults is highly individualized.

The treatment of AML in children is similar to that for younger adults. Induction therapy with chemotherapy, often cytarabine and anthracycline drugs including daunorubicin or doxorubicin, are used. However, there are different induction therapy regimens that can be used to treat children with AML. Decisions concerning treatment are made based on the factors discussed in the beginning of this section. As with adults, children with AML will go through a consolidation phase of treatment as well. Treatment of relapse in children is similar to treatment in younger adults. Physicians may recommend participation in a clinical trial.

What cells are affected in myelogenous leukemia?

What is the most common acute leukemia?

Where is acute myeloid leukemia found in the body?

What happens in acute myeloid leukemia?