Acute myeloid leukemia is treated with chemotherapy which reduces, or optimally, eradicates the leukemic clone. The stipulation for achieving long-term survival or curing the disease is that the patient must reach complete hematological remission (CHR).
CHR is defined as < 5% blasts in normal cellular bone marrow combined with normalized cell count in the blood. In practice, this is only achievable after infusion of chemotherapy with such a high dose intensity that the treatment is life-threatening. Chemotherapy will heavily affect normal hematopoiesis causing bone marrow aplasia with serious neutropenia, thrombocytopenia, and anemia, in periods from one to multiple weeks.
The patient's age is an indicator for what can reasonably be achieved. Induction treatment is appropriate for patients below about 60 years, while patients between 60-70 years can be treated to cure the disease only in certain cases. Patients older than 70 years will in the majority of cases, benefit most from good palliative treatment. An exception is patients with acute hypergranular promyelocyte leukemia (M3).
Curative treatment should take place at the hematology section of a regional hospital or a well-equipped central hospital with a designated section for blood diseases. There should be sufficient resources of blood banking and competent on-call personnel. If necessary, there should be cooperation with a regional hospital.
- Control the disease, possibly cytogenetically and molecularly.
- Cure the disease.