Patients who have achieved complete remission receive consolidation treatment to:
- Reinforce remission and lessening the risk for relapse
- Increase patient survival time
- Consolidation treatment can also be used to achieve a cure or as a bridgeātreatment to an allogeneic stem-cell transplantation (ASCT).
- Consolidation aims at destroying remaining leukaemia cells in the body and may consist of:
- Further chemotherapy
- An ASCT
Consolidation treatment with further chemotherapy, often at higher doses than that used for induction therapy, will depend on the patientās age, their physical fitness, chromosomal abnormalities detected, and importantly their risk of relapse.
For young patients (18-60 years):
- Low-risk AML: Further consolidation chemotherapy
- Intermediate-risk AML: 2 to 4 cycles of intermediate-dose cytarabine, with or without ASCT, depending on the chromosome abnormality
- High-risk AML: ASCT
In older adults:
- Low-risk AML: 2 to 3 cycles of low-dose cytarabine
- Intermediate- to high-risk AML: Hypomethylating drugs such as decitabine and azacitidine . Hypomethylating drugs inhibit the enzyme DNA methyltransferase which is vital for cell development
- Both azacitidine and decitabine help induce remission and control the progression of AML. Treatment can be given as required and it is not divided into induction and consolidation treatment.
- Azacitidine is approved for the treatment of AML patients with 20% to 30% of leukaemia cells in the blood and bone marrow.
- Decitabine is specifically approved for adult AML patients who cannot have standard induction chemotherapy.
