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Chemotherapy - Acute Myelogenous Leukemia (AML)

The most common drug treatment plan used to treat AML is the combination of 3 days of an anthracycline (e.g., daunorubicin, doxorubicin) and 7 days of ara-C. This plan is known as the three-plus-seven method. Some oncologists also add the drug 6-thioguanine to the mix (see option 2), although most studies indicate that this agent does not improve the rates or length of remission.

Please Note: The option number does not imply that one regimen is more effective than another.

Option 1: Chemotherapy with daunorubicin (Cerubidine®) or doxorubicin (Adriamycin®), plus cytarabine (ara-C;Cytosar-U®); also called "DA"

• How is it given:
  • Daunorubicin: intravenously (IV), the drug is delivered into the veins
  • Doxorubicin: IV
  • Cytarabine: IV
• What is the duration: Given as 3 days of anthracycline (daunorubicin, doxorubicin) plus 7 days of cytarabine
• What are the side effects: Daunorubicin - myelosuppression (impaired bone marrow function), cardiotoxicity (heart damage), gastrointestinal effects; doxorubicin - cardiotoxicity, worsening of symptoms caused by other drugs; cytarabine - gastrointestinal effects (nausea, vomiting, diarrhea), bleeding, fever

Option 2: Chemotherapy with daunorubicin (Cerubidine®) or doxorubicin (Adriamycin®), cytarabine (ara-C; Cytosar-U®), and 6-thioguanine (Tabloid®); also called "DAT"

Option 3: Chemotherapy with cytarabine (ara-C; Cytosar-U®) and idarubicin (Idamycin®)

Option 4: Chemotherapy with mitoxantrone (Novantrone®) and etoposide (VePesid®) **Not FDA-approved for the treatment of leukemia

Option 5: Chemotherapy with amsacrine (AMSA), cytarabine (ara-C; Cytosar-U®), and 6-thioguanine (Tabloid®). Individuals with the M3 subtype of AML - otherwise known as promyelocytic leukemia (PML) - benefit most from a special form of induction therapy using the drug all-trans retinoic acid (ATRA). In particular, patients who have genetic translocations of chromosomes 15 and 17 exhibit marked changes in their leukemic cells after ATRA therapy. ATRA induces terminal differentiation (maturation) of the leukemic cells and restored blood formation.

Option 6: Chemotherapy with all-trans retinoic acid (ATRA)

• How is it given: Orally
• What are the side effects: Hyperleukocytosis (increased number of white blood cells); syndrome of respiratory distress, fever, weight gain, edema, and pleural effusion (build-up of fluid within the pleura, the membranes that line the outer lungs and chest cavity) known as ATRA syndrome or retinoic acid syndrome

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