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Fred Hutch Cancer Center offers comprehensive care for acute myeloid leukemia (AML). The most common treatments for AML are chemotherapy, targeted therapy, immunotherapy and blood and marrow transplant. We also offer advanced treatments and new options available only through clinical trials.
Acute Myeloid Leukemia Care Tailored to You
You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.
Leading Experts in AML
As someone with AML, the best choice you can make is to receive care at an academic medical center, like Fred Hutch, 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 our partners at UW Medicine have 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.
There are many medicines approved for AML, and our scientists continue to research and discover promising new options. Choosing the best therapy for you is complex and requires:
- Carefully checking your health before treatment starts
- Comparing the benefits and risks of standard treatment and clinical trials
- Knowing what works for your AML subtype
Treatment Plans
Your Fred Hutch hematologist-oncologist works alongside an entire group of AML specialists. Every week, these experts meet to discuss patient treatment plans. This approach means each patient benefits from the experience of the whole group.
At these meetings, our specialists 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
If your physician is thinking about a blood and marrow transplant for you, they may meet with other experts, too, like a radiation oncologist and pathologist, to discuss this option.
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 Treatment Plans Differ
AML treatment is highly customized to meet each patient’s needs. The treatment plan depends on many factors, such as:
- Your subtype of AML (because different subtypes start, grow and respond to treatments differently)
- How your cancer cells look under a microscope (to see 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 perform normal daily activities on your own
- How well your liver and kidneys are working and other signs that indicate your health
- Your age
- If you have had another blood problem, like myelodysplastic syndrome
- If AML has spread to your brain and spinal cord
- If you’ve had chemotherapy to treat 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 this information to predict:
- The outlook for your AML
- If your body can tolerate intense treatment
- The risk that your disease will resist treatment or come back after treatment
This guides decisions about which therapies and clinical trials are best for you.
Standard Therapy For AML
Because AML includes 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 blood and marrow transplant. Targeted therapy and immunotherapy may also be recommended.
Chemotherapy
Many forms of chemotherapy are used for AML. It is the main treatment for most people.
Immunotherapy
A healthy immune system attacks bacteria, viruses and harmful cells, like cancer cells. It leaves harmless cells alone. Immunotherapies use the power of your immune system to fight AML cells.
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 so your natural defenses 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.
Targeted Therapy
For some AML subtypes, you 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 (also called immunotherapy)
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.
If you are having an infusion, you will get them 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
Here are several options that target different features of AML:
- Midostaurin and gilteritinib: Target AML with an FLT3-ITD gene mutation.
- Sorafenib: Targets AML with an FLT3-ITD gene mutation.
- Ivosidenib and enasidenib: Target AML with an IDH1 or IDH2 gene mutation.
- Gemtuzumab ozogamicin: Targets AML with the CD33 protein.
- Venetoclax: Targets AML with the BCL-2 protein.
- Glasdegib: Targets the SMO receptor, which is overactive on some AML cells.
Blood and Marrow Transplant
A blood and marrow transplant resets your body's ability to make healthy blood cells. Transplants for AML use donor stem cells (an allogeneic transplant).
Your physician may recommend a transplant as your post-remission therapy. Transplants work best when AML is in remission.
Your care team will include a transplant oncologist, transplant nurse, radiation oncologist, advanced practice providers, pharmacist, registered 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.
Your First Appointment
Some AML patients begin their care by coming to the Sloan Clinic, which is an outpatient clinic, to meet with a physician who specializes in AML. Other AML patients begin their care by going directly to the inpatient hospital at UW Medical Center - Montlake to start chemotherapy. After their hospital stay, they come to the Sloan Clinic for the first time.
Your first (pre-hospital) appointment at the Sloan Clinic is a time for you and your hematologist-oncologist to meet. You might meet your advanced practice provider, too. You will talk about your diagnosis and likely treatment. This visit is also a time for us to start getting to know you as a person. This helps us fit our recommendations to you. Together, you and your team will decide what needs to happen next.
We encourage you to bring a family member or friend to your first appointment (and any future visits).
Monitoring Your Health During AML Treatment
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 have 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.
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.
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
The Fred Hutch Patient Education team has video resources that go over how to keep common side effects at bay.