For most cancers, when you get a diagnosis, your doctor may tell you what stage you're in. One way they figures this out is to check the size, type, and location of your tumors. Acute myeloid leukemia (AML) is different because it usually doesn't cause tumors. So instead of stages, your doctor will use three broad categories of AML -- along with subtypes of the disease -- to figure out the best way to treat it.
Untreated Adult AML
The first category doctors use to classify acute myeloid leukemia is "untreated adult AML." This is when you've just been diagnosed with AML and the only treatment you may have had so far is to manage your symptoms.
Your doctor may also do tests to figure out what subtype of AML you have. There are two systems that classify AML subtypes.
The French-American-British (FAB) system has nine subtypes based on how your cells look under a microscope. The World Health Organization (WHO) system assigns subtypes based on a combination of things, such as:
- Leukemia cell forms and structures
- Markers on the cell surfaces
With this information, your doctor will suggest treatment. You may hear your doctor say that you need to start "remission induction therapy." In this phase of treatment, the goal is to get rid of the leukemia cells in your blood and bone marrow and put you in "remission," which means your cancer is under control.
One of the standard types of treatment is chemotherapy. These are drugs that stop cancer cells from growing, either by killing them or stopping them from dividing. You can take the drugs by mouth or injection. Your doctor can also place them directly into an organ, or into the fluid that flows around your brain and spinal cord, to reach cancer cells in those areas.
Your options for chemotherapy may include:
- Combination chemotherapy (more than one drug at a time)
- High-dose combination chemotherapy
- Low-dose chemotherapy
- Intrathecal chemotherapy (drugs placed directly into cerebrospinal fluid)
If you have a fast-growing AML called acute promyelocytic leukemia (APL), your doctor may suggest medicine called all-trans retinoic acid (ATRA), plus arsenic trioxide. You may also get ATRA along with combination chemotherapy, followed by arsenic trioxide.
You may get targeted therapy along with chemotherapy if your leukemia cells have a gene mutation called FLT3 or a protein called CD33.
Adult AML in Remission
If your doctor tells you that you're in remission, it's a sign that your cancer is under control. For AML, it means:
- Your CBC is normal
- Less than 5% of your bone marrow cells are leukemia cells
- You have no signs of leukemia in your body
Just because you're in remission doesn't mean you won't need treatment. You might enter a phase of treatment that your doctor calls "post-remission therapy." The goal is to get rid of any leukemia cells that may still be in your body.
Your doctor may want to continue your chemotherapy. They may also suggest radiation therapy at this time. Radiation uses different kinds of energy waves to get rid of cancer cells or stop them from growing.
A stem cell transplant is another treatment option. First, you get chemotherapy and possibly radiation therapy to kill your cancer cells. This process also kills healthy cells, so after that initial treatment you need to get stem cells (immature blood cells) to help create new healthy blood cells. Doctors will either use your own stem cells for the transplant or get stem cells from a donor.
Recurrent Adult AML
If you have recurrent AML, it means your treatments were successful but cancer cells have returned in your blood or bone marrow (with more than 5% leukemia cells in your bone marrow).
Your doctor may suggest treatment such as combination chemotherapy or a stem cell transplant. They may also recommend targeted therapy with medicine called monoclonal antibodies. Another option is treatment with arsenic trioxide.