As someone with acute myeloid leukemia (AML), the best choice you can make is to receive care at an academic medical center, like Fred Hutchinson Cancer Center, from physicians who specialize in AML. Research shows that patients do better when their care team has a high level of expertise in this disease.
Fred Hutch and UW Medicine developed a new care pathway and care teams to meet the needs of people with AML. Our model is designed to improve treatment results, including your quality of life.
Dozens of medicines are approved for AML, and our scientists work all the time on promising new options. Choosing the best therapy for you is complex. It requires:
- Knowing what works for your AML subtype
- Carefully checking your health before treatment starts
- Comparing the benefits and risks of standard treatment and clinical trials
At Fred Hutch, our AML experts have deep experience guiding patients and families through this process. We help you understand every choice and decide what is right for you.
ON THIS PAGE
Treatment Plan | Phases of Treatment | Treatment Process | Monitoring Your Health | Supportive Care Services | Continuing Care
Treatment Plan
AML treatment is highly customized and tailored to meet each patient’s needs.
How Do We Create Your Treatment Plan?
Your Fred Hutch hematologist-oncologist works alongside an entire group of AML specialists. Every week, these hematologist-oncologists meet to discuss their patients’ treatment plans. If your care team is thinking about a blood or marrow transplant for you, they may meet with other experts, too, like a radiation oncologist and pathologist, to talk about this option. Our approach means each patient benefits from the experience of the whole group.
The Fred Hutch experts at these meetings, including your physician, will:
- Talk about all possible treatments for your situation
- Decide which therapies will be most promising for you
- Check if any clinical trials match your needs, so you can think about joining them
Your care team will walk you and your caregiver through the treatment plan we recommend for you. You will have a chance to share your personal preferences, and you will decide together what happens next.
Why Do Treatment Plans Differ?
The treatment plan we design for you depends on many things, including:
- Your subtype of AML, because different subtypes start, grow and respond to treatments differently
- How your cancer cells look under a microscope (which normal, immature white blood cell your cancer is most like)
- If your AML cells have changes in certain chromosomes or genes
- How well you can do normal activities of daily living on your own (physicians call this your “performance status”)
- Other signs of health, like how well your liver and kidneys are working
- Your age
- If you have had another blood problem, like myelodysplastic syndrome
- If AML has spread to your brain and spinal cord
- If you had chemotherapy before for another cancer
- Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial
Your physician uses these things to predict:
- The outlook for your AML
- If your body can handle intense treatment
- The risk that your disease will resist treatment or come back after treatment
This guides our decisions about which standard therapies and clinical trials are best for you.
What Is The Standard Therapy For AML?
Because AML is a group of many subtypes of leukemia, there is no one way to treat everyone. But, in general, most people get chemotherapy in the hospital soon after they are diagnosed. Some people also get targeted therapy or immunotherapy. The goal is to put the disease into remission.
Next, patients have more treatment to clear any AML cells that might still be in the body. Often, this means getting chemotherapy in the clinic or having a bone marrow transplant. Again, targeted therapy and immunotherapy may also be options.
At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.
Our patients can also choose to receive promising, new AML therapies that you can get only through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can consider joining them.
Phases of Treatment
AML treatment is often done in three phases: induction, post-remission and maintenance.
The first phase, induction, is meant to bring on (induce) remission. The second phase, post-remission, is also known as consolidation. It is meant to get rid of any AML cells that might still be in your body. In the third phase, maintenance, some people go on to have therapy meant to keep AML from coming back, but not all patients need this.
For most AML subtypes, all three phases involve chemotherapy. Some people also get targeted therapy or immunotherapy. Others have a blood or marrow transplant. For the subtype called acute promyelocytic leukemia (APL), different kinds of medicines are used.
Chemotherapy
Many forms of chemotherapy are used for AML. It is the main treatment for most people.
Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing, which is how cancers grow.
Your hematologist-oncologist prescribes your chemotherapy and sets your treatment schedule. Most people get a combination of different chemotherapy medicines. Usually, chemotherapy is given by infusion through a peripherally inserted central catheter PICC or a Hickman line. Treatment happens in repeating cycles every two to six weeks.
After you finish induction therapy in the hospital, you will get infusions in a dedicated area of the clinic. Cancer nurses who are experts in infusions will give you these treatments. They will watch over you during the treatment, deal with any medical issues that come up and help keep you comfortable.
Some types of chemotherapy are given as a pill that you take at home.
Immunotherapy
Immunotherapies use the power of your immune system to fight AML cells. We are always looking for new options. A healthy immune system attacks bacteria, viruses and harmful cells, like cancer cells. It leaves harmless cells alone. Sometimes, cancer cells survive by sending false signals that make them look harmless, which tricks the immune system.
Medicines called immune checkpoint inhibitors block these false signals. This allows your natural defenses to work better. Fred Hutch was one of the first institutions in the world to research this kind of treatment in people with cancer. We continue to do clinical trials of immune checkpoint inhibitors and many other forms of immunotherapy, like CAR T-cell therapies, for people with AML.
Your hematologist-oncologist will prescribe your immunotherapy and set your treatment schedule.
Targeted Therapy
For some AML subtypes, yu may get targeted therapies. These are more exact than standard chemotherapy, which affects all fast-growing cells throughout the body.
Targeted therapies work in one of three ways:
- They target a gene or protein that causes cancer growth.
- They damage cancer cells directly.
- They tell your immune system to attack certain cells. This is also called immunotherapy.
Your hematologist-oncologist will prescribe your targeted therapy and set your treatment schedule. Targeted therapies are usually given as a pill that you take at home. Some are given by infusion through a peripherally inserted central catheter (PICC) or a Hickman line.
You will get infusions in a dedicated area of the clinic. Cancer nurses who are experts in infusions give you these treatments. They will watch over you during the treatment, deal with any medical issues that come up and help keep you comfortable.
Targeted therapies can be used alone or together with chemotherapy.
Options for Targeted Therapy
We have several options that target different features of AML. They include:
- Midostaurin and gilteritinib. They target AML with an FLT3-ITD gene mutation.
- Sorafenib. It targets AML with an FLT3-ITD gene mutation.
- Ivosidenib and enasidenib. They target AML with an IDH1 or IDH2 gene mutation.
- Gemtuzumab ozogamicin. It targets AML with the CD33 protein.
- Venetoclax. It targets AML with the BCL-2 protein.
- Glasdegib. It targets the SMO receptor, which is overactive on some AML cells.
Blood or Marrow Transplant
A blood or marrow transplant resets your body's ability to make healthy blood cells. Researchers at Fred Hutch pioneered this form of treatment.
Your physician may recommend a transplant as your post-remission therapy. Transplants work best when AML is in remission.
Transplants for AML use stem cells from a donor. This is called an allogeneic transplant.
A team of Fred Hutch transplant experts will care for you. Your team will include a transplant oncologist, transplant nurse, radiation oncologist, advanced practice providers, pharmacist, dietitian, team coordinator and social worker.
Physicians and researchers at Fred Hutch pioneered blood and marrow transplants decades ago. Today at Fred Hutch, we continue to refine transplant techniques and to develop new options.
Monitoring Your Health
While you are in active treatment, your AML care team will see you regularly for exams and tests to check:
- How well your treatment is working
- If there is any reason to change your treatment
- If you need help with side effects or supportive care services, like nutrition care or mental health counseling
We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.
Supportive Care Services
Along with treating your AML, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.
From dietitians and oncoreproduction specialists to social workers and spiritual health staff, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.
Learn more about Supportive Care
When your disease is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your AML. They will check your overall health and look for signs that your cancer has come back (signs of recurrence).
Your team will also help with any long-term side effects (which linger after treatment ends) or late effects (which may start after treatment is over).
If you do not live close to Fred Hutch and you prefer to travel here less often, we will work with your local health care providers to make sure you get the follow-up care you need.
For people who had a blood or marrow transplant, the Fred Hutch Long-Term Follow-Up Program provides lifelong monitoring and care.