Chemotherapy for Acute Myeloid Leukemia by Best Pediatric Hematologist Oncologist

Chemotherapy (chemo) is the use of anticancer drugs that are injected under the skin, or into the cerebrospinal fluid (CSF), or medicines taken by mouth to destroy or control cancer cells. In addition to being given in the CSF, these drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancers such as leukemia that have spread throughout the body.

Acute chemo may not be recommended for patients with poor health, but advanced age in itself is not a deterrent to receiving chemo.

Acute Myeloid Leukemia Treatment

How is chemo given?

Treatment of AML is usually divided into stages:

• Induction is the first stage of treatment. It is short and intense, usually lasting about a week. The goal is to clear the blood of leukemia cells (blasts) and to normalize the number of blasts in the bone marrow.

• Consolidation is a chemical that is given after the patient has recovered from induction. This is to kill the small number of leukemia cells that are still around but cannot be seen (since there are so few of them). For consolidation, chemo is given in cycles, each period of treatment followed by a period of rest so that the body has time to recover.

The third phase, called maintenance (or post-consolidation), involves giving low doses of chemo for months or years after the consolidation ends. It is often used to treat acute promyelocytic leukemia (APL), but is not usually used for other types of AML.

Most of the chemo drugs used to treat AML are given into a vein in the arm (IV), although some can be injected under the skin or taken by mouth as pills. Chemo may also be given into the CSF (known as intrathecal chemo) if there are signs that the leukemia has reached the brain or spinal cord (which is not common with AML). This can be done with a thin tube (catheter) that is inserted through a small hole in the skull (such as the Omaya reservoir) or during a lumbar puncture (spinal tap).

Most chemo regimens used to treat AML are intensive and can cause serious side effects, so treatment is usually given in a hospital.

What chemo drugs are used to treat AML?

The chemo drugs most often used to treat AML are a combination of:

• Cytarabine (Cytosine Arabinoside or Ara-C)

• an anthracycline medicine, such as daunorubicin (dainomycin) or idarubicin

Other chemo drugs that may be used to treat AML include:

• Cladribine (2-CDA)

• Fludarabine

• Mitoxantrone

• Etoposide (VP-16)

• 6-thioguanine (6-TG)

• Hydroxyurea

• Corticosteroid medications, such as prednisone or dexamethasone

• Methotrexate (MTX)

• 6-mercaptopurine (6-MP)

• azacitidine

• Decitabine

Possible Side Effects

Chemo drugs can affect some normal cells in the body, causing side effects. The side effects of chemo depend on the type and dose of the drugs given and for how long they are taken. Side effects may include:

• hair fall

• Mouth sores

• loss of appetite

• nausea and vomiting

• diarrhea or constipation

Chemo drugs also affect normal cells in the bone marrow, which can reduce the number of blood cells. This can lead to:

• Increased risk of infection (from having too few normal white blood cells)

• Easy bruising or bleeding (due to too few platelets in the blood)

Most side effects of chemo go away after treatment ends. Low blood cell counts may last for weeks, but should then return to normal. There are often ways to reduce these side effects. For example, medicines may be given to help prevent or reduce nausea and vomiting. Be sure to ask about medications to help reduce side effects, and tell your doctor or nurse when you have side effects so they can be managed effectively.

If your white blood cell count is very low during treatment, you can help reduce your risk of infection by carefully avoiding exposure to germs. During this time, your doctor or nurse may tell you:

• Wash your hands frequently.

• Avoid fresh, uncooked fruits and vegetables and other foods that may contain germs.

• Avoid fresh flowers and plants as they may harbor mildew.

• Make sure other people wash their hands before coming into contact with you.

• Avoid large crowds and sick people.

You may get antibiotics before you start showing signs of infection or early signs of infection developing (such as a fever). You may also find medicines that help prevent viral and fungal infections.

drugs known as growth factors, such as filgrastim (Neupogen), pegfi Lettuce transfusion to help stop the bleeding.

Low red blood cell counts: Shortness of breath and extreme fatigue due to low red blood cell count (anemia) can be treated with medications or a red blood cell transfusion.

Decisions about when a patient can leave the hospital are often influenced by their blood count. Some people find it helpful to keep track of their count. If you're interested in this, ask your doctor or nurse about your blood cell count and what these numbers mean.

Side effects of specific drugs: Some drugs have specific potential side effects. For example:

• High doses of cytarabine can cause dryness in the eyes and effects on certain parts of the brain, causing problems with coordination or balance. If these side effects appear, the dosage of the drug may need to be reduced or completely discontinued.

• Anthracyclines (such as daunorubicin or idarubicin) can harm the heart, so they may not be used in someone who already has heart problems.

Other organs that can be damaged by chemo drugs include the kidneys, liver, testicles, ovaries, and lungs. Pediatric Hematologist Oncologist Doctors and nurses monitor treatment carefully to limit the risk of these side effects as much as possible.

If serious side effects occur, chemo may need to be reduced or reduced, at least for a short time. Careful monitoring and adjustment of the dosage of the drug is important as some side effects may last for a long time.

Tumor lysis syndrome: This side effect of chemo may occur in patients who have large numbers of leukemia cells, mainly during the induction phase of treatment. It can affect the kidneys, which are not able to get rid of all these substances at once. An overdose of certain minerals can also affect the heart and nervous system. This can be prevented by giving extra fluids during treatment and by giving certain medications, such as bicarbonate, allopurinol, and raspberries, which help the body get rid of these substances.