Intensive chemotherapy treatment leads to significant granulocytopenia and thrombocytopenia. Therefore, frequent blood tests are necessary.
While the patient is hospitalized and receives aggressive combination treatment, and between later courses, hemoglobin, rod and segmental nucleated granulocyte counts, as well as platelets, should be checked at least twice a week after a course of chemotherapy until bone marrow regeneration.
Consolidation treatment also causes bone marrow aplasia for 1–2(3) weeks. There is a certain risk for serious CNS toxicity from high doses of cytarabine, which is not given to patients over 60 years. Caution must also be taken for patients with liver and kidney involvement.
During the intensive treatment period, the patient will, in periods from weeks to months, require hospitalization as a result of the treatment due to infections, the need for transfusions, and/or organ failure.
Chemotherapy of this intensity unfortunately leads to death in some patients, due to sepsis or other complications during the first months of treatment. This applies especially to elderly patients.
Liberal use of thrombocyte concentrates in combination with optimal doses of antimicrobial and antifungal agents is a prerequisite for safe treatment.
Nutritional problems occur, more or less, among patients receiving this treatment. This is due to nausea, vomiting, mucositis, diarrhea, dry mouth, pain, constipation, and changes in smell and taste senses. Many will require intravenous nutrition. Good nutritional guidance is important.
Mucositis, both in the mouth and other mucosa, often occurs when blood values are at their lowest. The intensity of the soreness is individual. Sore mucosa in the mouth is not only an entrance for bacteria, but can also be painful. Prophylactic mouth hygiene should be given during the entire treatment.
Nausea improves 1-2 days after a treatment. Some patients have lasting problems often of multifactorial etiology.
Hair loss will occur 2-3 weeks after starting chemotherapy.
Recurrence after treatment is finished
For recurrence of the disease, the possibility for reaching new remission with the original induction regimen is about 30-50% better the longer it has been since the conclusion of treatment. Therefore, if recurrence occurs more than 12 months after concluded treatment, it is usually recommended to try the original induction regimen first.
Recurrence during the first year after treatment will rarely reach remission with the original induction regimen, and the prognosis is poor. Treatment is planned individually.
If patients under 60 years reach a new CHR, an allogeneic stem cell transplantation is an option if a familial donor is available. A transplant from an unrelated donor may also be appropriate.