Treatment for AML

As someone with acute myeloid leukemia (AML), the best choice you can make is to receive care at an academic medical center, like Fred Hutchinson Cancer Center, from physicians who specialize in AML. Research shows that patients do better when their care team has a high level of expertise in this disease. 

Fred Hutch and UW Medicine developed a new care pathway and care teams to meet the needs of people with AML. Our model is designed to improve treatment results, including your quality of life. 

Dozens of medicines are approved for AML, and our scientists work all the time on promising new options. Choosing the best therapy for you is complex. It requires:

  • Knowing what works for your AML subtype
  • Carefully checking your health before treatment starts
  • Comparing the benefits and risks of standard treatment and clinical trials

At Fred Hutch, our AML experts have deep experience guiding patients and families through this process. We help you understand every choice and decide what is right for you.

Treatment Plan

AML treatment is highly customized and tailored to meet each patient’s needs.

How Do We Create Your Treatment Plan?

Your Fred Hutch hematologist-oncologist works alongside an entire group of AML specialists. Every week, these hematologist-oncologists meet to discuss their patients’ treatment plans. If your care team is thinking about a blood or marrow transplant for you, they may meet with other experts, too, like a radiation oncologist and pathologist, to talk about this option. Our approach means each patient benefits from the experience of the whole group.

The Fred Hutch experts at these meetings, including your physician, will:

  • Talk about all possible treatments for your situation
  • Decide which therapies will be most promising for you
  • Check if any clinical trials match your needs, so you can think about joining them

Your care team will walk you and your caregiver through the treatment plan we recommend for you. You will have a chance to share your personal preferences, and you will decide together what happens next.

Why Do Treatment Plans Differ?

The treatment plan we design for you depends on many things, including:

  • Your subtype of AML, because different subtypes start, grow and respond to treatments differently
  • How your cancer cells look under a microscope (which normal, immature white blood cell your cancer is most like) 
  • If your AML cells have changes in certain chromosomes or genes
  • How well you can do normal activities of daily living on your own (physicians call this your “performance status”)
  • Other signs of health, like how well your liver and kidneys are working
  • Your age
  • If you have had another blood problem, like myelodysplastic syndrome
  • If AML has spread to your brain and spinal cord
  • If you had chemotherapy before for another cancer
  • Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial

Your physician uses these things to predict:

  • The outlook for your AML
  • If your body can handle intense treatment
  • The risk that your disease will resist treatment or come back after treatment

This guides our decisions about which standard therapies and clinical trials are best for you. 

What Is The Standard Therapy For AML?

Because AML is a group of many subtypes of leukemia, there is no one way to treat everyone. But, in general, most people get chemotherapy in the hospital soon after they are diagnosed. Some people also get targeted therapy or immunotherapy. The goal is to put the disease into remission. 

Next, patients have more treatment to clear any AML cells that might still be in the body. Often, this means getting chemotherapy in the clinic or having a bone marrow transplant. Again, targeted therapy and immunotherapy may also be options.

At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.

Our patients can also choose to receive promising, new AML therapies that you can get only through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can consider joining them.

Phases of Treatment

AML treatment is often done in three phases: induction, post-remission and maintenance.

The first phase, induction, is meant to bring on (induce) remission. The second phase, post-remission, is also known as consolidation. It is meant to get rid of any AML cells that might still be in your body. In the third phase, maintenance, some people go on to have therapy meant to keep AML from coming back, but not all patients need this.

For most AML subtypes, all three phases involve chemotherapy. Some people also get targeted therapy or immunotherapy. Others have a blood or marrow transplant. For the subtype called acute promyelocytic leukemia (APL), different kinds of medicines are used. 

Induction Therapy

The goals of induction therapy are to put your AML in remission and keep you healthy enough to move on to post-remission therapy. For most people, this means going into the hospital to get intense chemotherapy. 

If you have APL, you will get different medicines. They are all-trans retinoic acid (ATRA), also called tretinoin, with either chemotherapy or arsenic trioxide (ATO).

Almost all Fred Hutch patients have induction therapy at the inpatient hospital at UW Medical Center - Montlake. (A small number of patients do not have to be in the hospital.) Physicians and nurses there specialize in taking care of people with AML. They are part of Fred Hutch and UW Medicine. 

They will give you your induction medicines through a peripherally inserted central catheter (PICC) or a Hickman line. 

In the past, people with AML needed to stay in the hospital for four to five weeks for induction. Our physicians and researchers have designed a special care pathway to give you high-quality care that lets you return home much sooner.

A typical hospital stay for Fred Hutch AML patients is about a week. Sometimes, it is longer. Some people need more than one course of induction therapy to get to remission. 

During your stay, your team will watch your health closely. They will provide any care you need for side effects or other medical problems. They will also check your blood and bone marrow to see how your AML responds to treatment. 

We know you would rather be at home. We will release you from the hospital as soon as we believe it is safe for you. The South Lake Union Clinic, our outpatient clinic, is set up to provide most of the care you might need in the days and weeks right after induction. For example, the clinic offers infusion services 365 days a year. A special clinic team will closely manage your AML care to reduce the chances that you will need to return to the hospital.

Post-Remission Therapy

After you leave the hospital, you will come to the outpatient clinic for appointments. You will see your AML physician, nurse and advanced practice provider often. We will check how you are doing, give you post-remission therapy and look at the results.

The goal of post-remission therapy is to get rid of any AML cells that are still there after induction. This is important to keep the cancer from coming back. The main options for AML are chemotherapy or a blood or marrow transplant. Targeted therapy and immunotherapy are sometimes used, too. 

If you have APL, you will get chemotherapy along with ATRA or ATO. With APL, it is common to stay on this for several months or up to a year. 

During post-remission therapy, we will test your blood regularly to see how your AML responds. This helps us know if we need to change your treatment. Changes could include:

  • Switching to a different medicine, like a different chemotherapy 
  • Having another form of treatment, like a blood or marrow transplant
  • Joining a clinical trial so you can get a new therapy

Maintenance Therapy

If induction therapy put your AML in remission, but you are not able to finish post-remission therapy (for example, if the chemotherapy is too intense and you cannot have a transplant), there are other options. You may be able to have maintenance therapy with a chemotherapy pill (azacitidine) that you take at home. Patients may stay on this medicine as long as it keeps their AML under control.

Treatment Process

Different subtypes of AML progress and respond to treatments in different ways. We choose, combine and schedule your treatments based on what works for your subtype. Your care team will make sure you understand each type of treatment and all of your choices.


Many forms of chemotherapy are used for AML. It is the main treatment for most people.

Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing, which is how cancers grow. 

Your hematologist-oncologist prescribes your chemotherapy and sets your treatment schedule. Most people get a combination of different chemotherapy medicines. Usually, chemotherapy is given by infusion through a peripherally inserted central catheter PICC or a Hickman line. Treatment happens in repeating cycles every two to six weeks.

After you finish induction therapy in the hospital, you will get infusions in a dedicated area of the clinic. Cancer nurses who are experts in infusions will give you these treatments. They will watch over you during the treatment, deal with any medical issues that come up and help keep you comfortable.

Some types of chemotherapy are given as a pill that you take at home. 

Learn More About Chemotherapy


Immunotherapies use the power of your immune system to fight AML cells. We are always looking for new options. A healthy immune system attacks bacteria, viruses and harmful cells, like cancer cells. It leaves harmless cells alone. Sometimes, cancer cells survive by sending false signals that make them look harmless, which tricks the immune system. 

Medicines called immune checkpoint inhibitors block these false signals. This allows your natural defenses to work better. Fred Hutch was one of the first institutions in the world to research this kind of treatment in people with cancer. We continue to do clinical trials of immune checkpoint inhibitors and many other forms of immunotherapy, like CAR T-cell therapies, for people with AML.

Your hematologist-oncologist will prescribe your immunotherapy and set your treatment schedule.

Learn More About Immunotherapy

Targeted Therapy

For some AML subtypes, yu may get targeted therapies. These are more exact than standard chemotherapy, which affects all fast-growing cells throughout the body.

Targeted therapies work in one of three ways:

  • They target a gene or protein that causes cancer growth.
  • They damage cancer cells directly.
  • They tell your immune system to attack certain cells. This is also called immunotherapy.

Your hematologist-oncologist will prescribe your targeted therapy and set your treatment schedule. Targeted therapies are usually given as a pill that you take at home. Some are given by infusion through a peripherally inserted central catheter (PICC) or a Hickman line. 

You will get infusions in a dedicated area of the clinic. Cancer nurses who are experts in infusions give you these treatments. They will watch over you during the treatment, deal with any medical issues that come up and help keep you comfortable.

Targeted therapies can be used alone or together with chemotherapy.

Options for Targeted Therapy

We have several options that target different features of AML. They include:

  • Midostaurin and gilteritinib. They target AML with an FLT3-ITD gene mutation.
  • Sorafenib. It targets AML with an FLT3-ITD gene mutation.
  • Ivosidenib and enasidenib. They target AML with an IDH1 or IDH2 gene mutation.
  • Gemtuzumab ozogamicin. It targets AML with the CD33 protein.
  • Venetoclax. It targets AML with the BCL-2 protein. 
  • Glasdegib. It targets the SMO receptor, which is overactive on some AML cells.
Learn More About Targeted Therapy

Blood or Marrow Transplant

A blood or marrow transplant resets your body's ability to make healthy blood cells. Researchers at Fred Hutch pioneered this form of treatment.

Your physician may recommend a transplant as your post-remission therapy. Transplants work best when AML is in remission. 

Transplants for AML use stem cells from a donor. This is called an allogeneic transplant. 

A team of Fred Hutch transplant experts will care for you. Your team will include a transplant oncologist, transplant nurse, radiation oncologist, advanced practice providers, pharmacist, dietitian, team coordinator and social worker.

Physicians and researchers at Fred Hutch pioneered blood and marrow transplants decades ago. Today at Fred Hutch, we continue to refine transplant techniques and to develop new options.

Learn More About Blood and Marrow Transplants

Monitoring Your Health

While you are in active treatment, your AML care team will see you regularly for exams and tests to check:

  • How well your treatment is working
  • If there is any reason to change your treatment
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling

We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.

Possible Results of Treatment

Throughout treatment, your care team looks for signs of:

  • Active disease: AML is still in the body during or after treatment, or it has come back.
  • Measurable residual disease: A small number of cancer cells are still in the body after treatment.
  • Remission: No signs of disease after treatment. Your blood cell counts are normal, your bone marrow has less than 5 percent blasts without any evidence of AML cells, and you have no AML signs or symptoms.
  • Relapse: The disease, signs or symptoms have come back after they had improved.
  • Refractory disease: The disease does not respond to treatment.

What about “cured”? Sometimes physicians use the word “cured” if you have been in complete remission for at least five years. After five years, cancer is less likely to come back (recur), but recurrence is still possible.

Managing Side Effects

You might be wondering about possible side effects from treatment, like hair loss or nausea from chemotherapy. If you are, it might be helpful to know that many of today’s treatments are more targeted to cancer cells, so they don’t cause the same side effects as standard chemotherapy. 

You are always at the center of everything we do. AML physicians, nurses and advanced practice providers are here to help prevent or manage the side effects of treatment.

Get Help with Side Effects

Before you begin treatment, we talk with you about what to expect, based on your treatment plan, and what can help if you do have side effects.

At your appointments, we want you to tell us about any side effects you are having. If you have questions or concerns between appointments, you can call or email us. We will make sure you know how to reach care providers at Fred Hutch after hours, if that is when you need us.

We have many tools to help you feel better, such as:

  • Antibiotics and antiviral drugs to prevent or treat infections
  • Transfusions, steroids and medicines that help the immune system to treat low levels of blood cells (low blood counts)
  • Nutrition care and medicines to help with digestive problems
  • Conventional and integrative therapies for pain

Coping with Side Effects

Common Side Effects

Side effects are different depending on which treatment you get. They also depend on other things, like how strong your immune system is. These are some of the common side effects of AML treatment:

  • Unusual tiredness (fatigue)
  • Hair loss
  • Higher risk of infection (due to low levels of white blood cells)
  • Anemia (due to low levels of red blood cells)
  • Easy bruising or bleeding (due to low levels of platelets)
  • Problems in your digestive tract, like sores in your mouth, nausea or vomiting 

Supportive Care Services

Along with treating your AML, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From dietitians and oncoreproduction specialists to social workers and spiritual health staff, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need. 

Learn more about Supportive Care

Caregiving During Treatment

If your loved one is getting chemotherapy, targeted therapy or immunotherapy, there are many ways you can help. Caregiving during active treatment for AML often means doing tasks like these:

  • Keeping track of their appointments and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of things at home that they may not be able to do, like grocery shopping and cleaning

Caregiving for Transplant Patients

Caregivers have a special role in blood and bone marrow transplants. This intense treatment involves chemotherapy (and sometimes radiation) with serious side effects. During the initial recovery period, which often takes at least a month, your loved one will need daily help. We have classes to help transplant caregivers get ready. During recovery, a transplant registered nurse is available by phone 24 hours a day, 7 days a week, to help you.

Continuing Care

When your disease is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your AML. They will check your overall health and look for signs that your cancer has come back (signs of recurrence).  

Your team will also help with any long-term side effects (which linger after treatment ends) or late effects (which may start after treatment is over). 

If you do not live close to Fred Hutch and you prefer to travel here less often, we will work with your local health care providers to make sure you get the follow-up care you need.  

For people who had a blood or marrow transplant, the Fred Hutch Long-Term Follow-Up Program provides lifelong monitoring and care.  

Schedule for Follow-up Visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your hematologist-oncologist will base your schedule on many factors, including:

  • Your AML subtype and risk group  
  • Which treatments you had and how your disease responded
  • How the disease and treatments affected you
  • How long it has been since your treatment ended 

Most patients have follow-up appointments for at least five years. It is common to have visits more often in the first months and years after active treatment ends and less often as time goes on. This will depend on your exact needs.

What Happens at Follow-up Visits

Follow-up for AML typically means seeing your hematologist-oncologist for a physical exam and having blood tests to check your blood cell levels. If there are any changes, you might have tests to check the health of your bone marrow.  

Together, you and your physician will talk about the benefits and risks of any follow-up options and decide what is right for you. 

Meet the Acute Myeloid Leukemia Care Team