How To Treat Leukaemia

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1 Chemotherapy for acute myeloid leukaemia (AML) 1 Chemotherapy for acute myeloid leukaemia (AML) This information is from the booklet Understanding acute myeloid leukaemia. You may find the full booklet helpful. We can send you a free copy see page 6. Contents What is chemotherapy? Induction chemotherapy Consolidation chemotherapy Low-dose chemotherapy treatment How chemotherapy is given More information and support What is chemotherapy? Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy leukaemia cells. The drugs travel round the body in the bloodstream. Chemotherapy disrupts the way leukaemia cells grow and divide, but it also affects normal cells. For people who have just been diagnosed with AML, it s important to start treatment as soon as possible. Treatment for AML is given in two main phases: induction and consolidation.

2 Chemotherapy for acute myeloid leukaemia (AML) 2 Induction chemotherapy The main aim of treatment for AML is to try to cure it. The first step is to achieve a remission. Remission is when no leukaemia cells can be found in the blood or bone marrow and normal bone marrow has developed again. The treatment given is called induction chemotherapy. Most people have two cycles of induction chemotherapy. You may be able to go home between treatments if you are well enough. The possible side effects of the treatment are discussed in our booklet Understanding acute myeloid leukaemia. The most commonly used induction chemotherapy drugs are: cytarabine (Ara C, cytosine arabinoside) daunorubicin idarubicin (Zavedos ) fludarabine (Fludara ). Sometimes induction chemotherapy does not destroy all the leukaemia cells. You may be given further cycles of chemotherapy to get the leukaemia into remission. Consolidation chemotherapy The aim of consolidation chemotherapy is to get rid of any leukaemia cells that may remain after induction chemotherapy but can t be seen. It is given to reduce the risk of the leukaemia coming back. The most commonly used drugs for consolidation chemotherapy are: cytarabine etoposide amsacrine (Amsidine ) mitoxantrone.

3 Chemotherapy for acute myeloid leukaemia (AML) 3 Low-dose chemotherapy treatment If you are not fit enough to have intensive induction therapy or choose not to have it, low-dose chemotherapy may be a treatment option. The chemotherapy drugs may be given by drip (infusion) or by injection under the skin (subcutaneous). You may have this as an outpatient. The common drugs used for this treatment are cytarabine and azacitidine. The doctors will follow you closely to see how well your leukaemia is responding to the chemotherapy. They will plan what further treatment is necessary depending on how the leukaemia responds. Our booklet Understanding chemotherapy discusses the treatment and its side effects in more detail. We can also send you information about individual drugs and their particular side effects. How chemotherapy is given Chemotherapy drugs for AML are usually given into a vein (intravenously). This might be by a drip (intravenous infusion) or by injection. Chemotherapy given into a vein goes straight into the bloodstream. This means it can get to all areas of your body. Your treatment is usually given through a central line, PICC line or implantable port. Central lines Most people having treatment for AML will have a central line. A central line is a long, thin, hollow tube that is inserted into a vein in your chest. Hickman and Groshong lines are both commonly used types of central line. A central line can be used to give chemotherapy intravenously and to take blood samples, so you won t need repeated injections or needles put into your vein while you have one. It is designed to stay in place for many months, throughout all your chemotherapy treatment sessions. You will be given a general or local anaesthetic before the central line is put in. The doctor or chemotherapy nurse will explain the procedure to you. After the line has been put in place you may have some mild pain or stiffness for a few days. Your doctor can give you painkillers for this.

4 Chemotherapy for acute myeloid leukaemia (AML) 4 A central line 1 Central line inserted into chest here 2 Line tunnelled under skin 3 Line comes out here The heart The nurses can show you how to care for your line to prevent blockages or infection. Before you go home, make sure you re confident about looking after it. If you have any problems, contact the staff in the chemotherapy clinic or on the ward for advice. If you re not comfortable looking after the line yourself, then you can be referred to a district nurse who can help look after the line while you re at home. PICC lines Instead of a central line, a PICC line (peripherally inserted central venous catheter) or an implantable port may be used. A PICC line is a long, thin tube put into a vein near the crook of your arm. Implantable ports An implantable port is a thin, soft plastic tube that s put into a vein in the chest and has an opening (port) just under the skin of the chest or arm. Your doctor or chemotherapy nurse will explain the procedure to you. You ll be given a local anaesthetic before the line is put in. We can send you information about central lines, PICC lines and implantable ports.

5 Chemotherapy for acute myeloid leukaemia (AML) 5 Supportive care During your chemotherapy, you ll also need treatment for the symptoms caused by a lack of normal blood cells. Lower numbers of blood cells may be due to both the leukaemia itself and the chemotherapy. Supportive care includes having a drip (transfusion) of red blood cells and platelets to replace your normal blood cells. You will also need antibiotics to prevent and treat any infections. To prevent an infection you may be given antibiotics tablets. To treat an infection the antibiotics are given through your central line. Our booklet Coping with fatigue has more helpful tips.

6 Chemotherapy for acute myeloid leukaemia (AML) 6 More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. Visit macmillan.org.uk or call us on , Monday to Friday, 9am to 8pm. You can order a copy of Understanding acute myeloid leukaemia, or any other cancer information, from be.macmillan.org.uk or by calling us. Hard of hearing? Use textphone , or Text Relay. Speak another language? We have telephone interpreters. We provide information in a range of languages and formats. Visit macmillan.org.uk/otherformats or call us. We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ Revised in November, Next planned review in 2018.