Chemotherapy for AML is typically divided into two phases: remission induction and post-remission therapy. The goal of the remission induction phase is to induce a remission, a state in which there is no visible evidence of disease and blood counts are normal. In the next phase, the post-remission therapy phase, patients may receive high doses of chemotherapy to eliminate any remaining leukemic cells.
Immunotherapy
Physicians may include immunotherapeutic drugs throughout the course of treatment. These agents are designed stimulate the patient's own immune system to recognize and attack the leukemic cells. Immunotherapy agents include interferon alpha, which occurs naturally in the body, and monoclonal antibodies, which are genetically engineered proteins designed to target specific sites (antigens) on the surface of tumor cells. Monoclonal antibodies may be able to destroy diseased cells directly, or they may be used in a "conjugated" form, with radioisotopes (radioactive substances that irradiate tumor cells), drugs, or toxins designed to destroy tumor cells attached to it.
Treatment for CNS Involvement
In rare cases, AML can spread to the central nervous system (CNS) -- the brain and the spinal cord. Moderate doses of chemotherapy administered intravenously are ineffective in reaching the CNS, which is shielded from toxins by the blood-brain barrier, so physicians may administer chemotherapy intrathecally -- directly into the spinal column, into the fluid that bathes the spinal cord and brain.
Treatment for APL
Following recent studies of specific agents in patients with acute promyelocytic leukemia (APL), physicians have established treatment guidelines that differ from those for other forms of AML. Most APL patients are now treated initially with all-trans-retinoic acid (ATRA) -- an agent whose use was developed in the United States at Memorial Sloan-Kettering. In the small percentage of patients who relapse after remission, treatment may include arsenic trioxide, another agent used first in the United States at Memorial Sloan-Kettering.
