- 1. Chemotherapy
- 2. Radiotherapy
- 3. Bone marrow transplantation
- 4. Target therapy and immunotherapy
- 5. Car T-Cell gene therapy
The treatment for acute myeloid leukemia, also known as AML, is indicated by a hematologist and consists mainly of chemotherapy in which drugs are applied directly to the vein, such as idarubicin and daunorubicin, to destroy cancer cells of the disease, and in in some rarer cases, medicines can be used in the form of pills.
Acute myeloid leukemia is a disease in which blood cells undergo genetic mutations, giving rise to a type of cancer that has different characteristics, so the treatment changes from one person to another, and it may be necessary to perform bone marrow transplantation, for example. example. Learn more about the types of acute myeloid leukemia and what the symptoms are.
In addition, acute myeloid leukemia may respond worse to treatment than other types of leukemia and, therefore, in some cases, the cure is more difficult, but currently new types of treatments for this disease are being developed, such as target therapy, which attack cells with specific genetic changes, immunotherapy and Car T-cell therapy. The following are the treatment options for acute myeloid leukemia:
1. Chemotherapy
Treatment for acute myeloid leukemia begins with a type of chemotherapy called induction, which aims at remission of the cancer, this means reducing the sick cells until they are not detected in the blood tests or in the myelogram, which is the examination of the collected blood directly from the bone marrow.
This type of treatment is indicated by the hematologist, is performed in an outpatient clinic of a hospital and is carried out by applying medications directly to the vein, through a catheter placed on the right side of the chest called a port-a-cath or by a access in a vein of the arm.
In most cases of acute myeloid leukemia, the doctor recommends that the person receives a set of various medications, called protocols, which are mainly based on the use of drugs such as cytarabine and idarubicin, for example. These protocols are done in phases, with days of intense treatment and a few days of rest, which allow the person's body to recover, and the number of times to be done depends on the severity of AML.
Some of the most common medications to treat this type of leukemia can be:
|
Cladribine |
Etoposid | Decitabine |
| Cytarabine | Azacitidine | Mitoxantrone |
| Daunorubicin | Thioguanine | Idarubicin |
| Fludarabine | Hydroxyurea | Methotrexate |
The doctor may also recommend the use of corticosteroids, such as prednisone or dexamethasone, as part of the treatment protocol for acute myeloid leukemia. Some research is being developed so that new drugs such as capecitabine, lomustine and guadecitabine are also used to treat this disease.
In addition, after remission of the disease with chemotherapy, the doctor can indicate new types of treatment, called consolidation, which serves to ensure that the cancer cells have all been eliminated from the body. This consolidation can be done through high-dose chemotherapy and bone marrow transplantation.
Treatment for acute myeloid leukemia with chemotherapy reduces the amount of white blood cells in the blood, which are the body's defense cells, and the person has low immunity, making them more susceptible to infections. Therefore, in some cases, the person needs to be admitted to a hospital during treatment and must use antibiotics, antivirals and antifungals to prevent infections from arising. And yet, it is common for other symptoms to appear, such as hair loss, swelling of the body and skin with spots. Know other side effects of chemotherapy.
2. Radiotherapy
Radiotherapy is a type of treatment that uses a machine that emits radiation into the body to kill cancer cells, however, this treatment is not widely used for acute myeloid leukemia and is only applied in cases where the disease has spread to other organs, like the brain and testis, to be used before bone marrow transplantation or to relieve pain in a bone area invaded by leukemia.
Before starting the radiotherapy sessions, the doctor makes a plan, verifying computed tomography images so that the exact location in which the radiation must be reached in the body is defined and then markings are made on the skin, with a specific pen, to indicate the right position on the radiotherapy machine and so that all sessions are always in the marked location.
Like chemotherapy, this type of treatment can also result in side effects, such as tiredness, loss of appetite, nausea, sore throat and skin changes similar to sunburn. Learn more about the care that should be taken during radiation therapy.
3. Bone marrow transplantation
Bone marrow transplantation is a type of blood transfusion made from hematopoietic stem cells taken directly from the bone marrow of a compatible donor, either by a blood aspiration surgery from the hip or through apheresis, which is a machine that separates the blood stem cells through a catheter in the vein.
This type of transplant is usually done after high doses of chemotherapy or radiotherapy drugs are performed and only after the cancer cells are not detected in the tests. There are several types of transplantation, such as autologous and allogeneic, and the indication is made by the hematologist according to the characteristics of the person's acute myeloid leukemia. See more about how bone marrow transplantation is done and the different types.
4. Target therapy and immunotherapy
Targeted therapy is the type of treatment that uses drugs that attack cells sick with leukemia with specific genetic changes, causing fewer side effects than chemotherapy. Some of these medications used are:
- FLT3 inhibitors: indicated for people with acute myeloid leukemia with mutation in the FLT3 gene and some of these drugs are midostaurin and gilteritinib, not yet approved for use in Brazil; HDI inhibitors: recommended by the doctor for use in people with leukemia with a mutation in the IDH1 or IDH2 genes , which prevent the adequate maturation of blood cells. HDI inhibitors, such as enasidenib and ivosidenib, can help leukemia cells mature to normal blood cells.
In addition, other drugs that act on specific genes are also being used as inhibitors of the BCL-2 gene, such as venetoclax, for example. However, other modern remedies based on helping the immune system fight leukemia cells, known as immunotherapy, are also highly recommended by hematologists.
Monoclonal antibodies are immunotherapy drugs created as proteins of the immune system that act by attaching themselves to the wall of AML cells and then destroying them. Gemtuzumab is a type of medicine that is highly recommended by doctors to treat this type of leukemia.
5. Car T-Cell gene therapy
Gene therapy using the Car T-Cell technique is a treatment option for people with acute myeloid leukemia that consists of removing cells from the immune system, known as T cells, from a person's body and then sending them to the laboratory. In the laboratory, these cells are modified and substances called CARs are introduced so that they are able to attack cancer cells.
After being treated in the laboratory, the T cells are replaced in the person with leukemia so that, modified, they destroy the cells sick with cancer. This type of treatment is still being studied and is not available by SUS. Check out more about how Car T-Cell therapy is performed and what can be treated.
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