Acute Myeloid Leukemia AML:Treatment,Relapse Chances,Future Hold

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Acute Myeloid Leukemia (AML)

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Results

ACUTE MYELOID LEUKEMIA

Related topics

Introduction and Clinical Features

Classification,Diagnosis and Prognostic Factors

Dr Ira Shah
M.D, DCH(Gold Medalist), FCPS, DNB
Edited by Dr. Bharat R Agarwal
Consultant Pediatric Hematologist and Oncologist.

Q. How is AML treated?

A. Between 75 - 85% can achieve a complete remission following appropriate induction chemotherapy. The mainstay of treatment is systemically administered chemotherapy. Treatment of the CNS is essential in AML, but has not yet shown to have an effect on survival.

Treatment is usually divided into

Induction (to achieve remission)
Consolidation
Past remission intensification (optional).

Maintenance therapy does not appear to have any value.

Treatment of AML is usually associated with severe and protracted myelosuppression and other complications. Children who receive intensive chemotherapy (including anthracyclines) should be periodically assessed for cardiac, renal and auditory function.

Induction chemotherapy

The 2 most effective drugs used to induce remission include cytarabine (Ara-C) and an anthracycline. Usually 70 -85% of children achieve remission with these drugs. Children with M3 sub-type should be induced with all-trans retinoic acid.

Complete response (remission) is defined as the following for at least 4 weeks.

Restoration of normal blood counts.
Maturation of all hematopoeitic cell lines.
Less than 5% blasts on a normocellular bone marrow.

Consolidation

The aim is to prolong the duration of the initial remission with either additional chemotherapy or bone marrow transplantation (BMT). Survival with chemotherapy alone is 35-40%. Hence BMT is indicated in most patients. However, in absence of a suitable marrow donor, intensive chemotherapy is given e.g. VAPA and epipodophyllotoxin based regimes.

In Down's children, chemotherapy usually cures AML and BMT is not indicated in 1st remission.

Q. What are the chances of relapse?

A. Various statistical studies show that median duration of complete remission is 12 - 18 months with some form of intensive post - remission therapy. There is 25 - 50% chance of 3 - 5 year disease free interval in selected studies. Relapses are rare after 4 - 5 years. However, prognosis for a child with recurrent or progressive AML is poor. The long term survival rates after BMT is 45 - 50% (first remission), 25 - 30% (second remission), 15 - 20% (in relapse). However, the mortality rate after BMT is approximately 25 - 50%. The major causes of morbidity and mortality are infection and bleeding due to pancytopenia.

Q. What does the future hold for AML?

A. Various clinical trials are trying newer methods of therapy like:-

Monoclonal antibodies to optimize graft Vs leukemia effect.
Agents to overcome multidrug resistance.
Other anti neoplastic agents to improve remission duration (e.g. Etoposide).

Thus, in future, various novel and effective treatments may be available for AML.

Last created on 13-07-2001
Last updated on 01-07-2006

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