Induction Therapy for Acute Myeloid Leukemia

Non-intensive induction therapy

Not everyone can tolerate intensive chemotherapy. You may need less aggressive treatment if you're over 75 or you have a condition like heart failure or lung disease. Your age and health conditions could put you at higher risk for complications from high-dose chemotherapy.

Instead, you'll take these medicines:

• A lower dose of a chemotherapy drug like azacitidine (Vidaza), cytarabine, or decitabine (Dacogen), plus
• A targeted drug such as venetoclax (Venclexta)

You may get another targeted drug too if your cancer cells test positive for a protein or gene mutation:

• Ivosidenib (Tibsovo) for the IDH1 gene mutation
• Enasidenib (Idhifa) for the IDH2 gene mutation
• Quizartinib (Vanflyta) or sorafenib (Nexavar) for the FLT3 gene mutation
• Gemtuzumab ozogamicin (Mylotarg) for the CD33 protein

Treatment is specific to your health and cancer traits

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How to Prepare for Induction Therapy

In the first step of induction therapy, your doctor decides whether you get intensive therapy or non-intensive therapy. Then they choose which cancer medicines to give you. Your doctor might also prescribe medicines like antifungal drugs or antibiotics to prevent infections and other treatment side effects.

Before treatment starts, it helps to meet with your hospital's social worker. You'll have a lot of paperwork to fill out, especially if you need to take time off from work. And you may not have much time in between your diagnosis and hospital admission to get everything done. The social worker can make sure you have all the information you need for induction therapy. They'll also tell you what to expect during treatment.

Build up your strength for the intense treatment ahead. Eat a healthy diet rich in protein, carbohydrates, and good fats. Walk or do other exercises. "The more physically active patients are, the better they feel and the less muscle weakness they develop at the end of [treatment]," Desai says.

Also ready your mind for the challenges that may lie ahead. "Some days are good. Some days you're fighting an infection," Desai says. "You have to keep up your spirits."

A solid support system is very important during AML treatment. Ask your partner, a friend, or other family members to go through the process with you. They can be there when you need to talk or ask for help.

What to Expect During Induction Therapy

Most people stay in the hospital for about one month, Desai says. You will get constant infusions of chemo into a vein for seven days, which isn't possible to do at home.

Another reason for the hospital stay is so doctors and nurses can monitor you and treat you for side effects like infections. Leukemia already lowers your body's ability to fight germs because the cancer cells crowd out infection-fighting white blood cells in your bone marrow. Chemotherapy drugs destroy even more white blood cells. You may need antibiotics to prevent infections and growth factors to raise your white blood cell counts.

With non-intensive therapy, you have a choice. You can stay at home or in the hospital. If you stay home, you'll go to the hospital every day for seven days to get an infusion or injection of the medicine.

At home you'll have to check yourself for symptoms. "For any fever, you need to make a prompt ER visit. Because of both the leukemia and the therapy, you will have a very low immune system for at least three weeks," Desai says. "An infection could turn complicated and serious if you sit home and ignore a fever." If you do get an infection or other complication, you will need to go to the hospital for treatment.

Remission

The goal of induction therapy is to put you into remission. Most people — about 2 out of 3 — do achieve remission. When you're in remission, it means your bone marrow contains fewer than 5% of blast cells, your blood cell counts are normal, and you have no signs or symptoms of leukemia.

Remission isn't the same as a cure. "It doesn't mean that every last leukemia cell is gone," Desai says. "You usually have to follow up with post-induction therapy, which we generally consider consolidation therapy or maintenance therapy."

Consolidation therapy includes several cycles of high-dose or low-dose chemotherapy. The goal is to destroy any leukemia cells that are left and prevent a relapse. A stem cell transplant is an option if you're healthy enough. It's an intense treatment, but it offers a chance to cure leukemia.

You might need more treatment after consolidation therapy. Maintenance therapy or post-consolidation therapy gives you lower doses of medicine over a long period of time. Staying on the treatment long-term helps to prevent the cancer from coming back.