Although each patient is treated on an individual basis, intensive chemotherapy treatment is normally appropriate if you’re under 70–75 years of age and you have good medical fitness.
You’ll have intensive treatment in two phases called remission induction therapy and consolidation therapy. This treatment involves strong chemotherapy which often successfully kills the leukaemia cells, but it’s associated with more severe side effects. You’ll usually have three to four courses (sometimes called blocks or cycles) of chemotherapy over four to six months. Each course of chemotherapy lasts a few days, and you’ll normally recover from each course in about three to six weeks.
You’ll have most of your remission induction and consolidation treatment as an inpatient in hospital, but nearly all patients will get some time at home, even if it’s just for a few days.
Most patients get to go home for a week or so in between courses, usually just after chemotherapy has finished. During this time you’ll be monitored closely a couple of times a week. If you need them, you’ll be given blood and platelet transfusions, to support your body and reduce some of the symptoms you may be getting.
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Remission induction therapy
The remission induction phase aims to clear leukaemia cells from your blood and bone marrow and quickly get your bone marrow working normally again. This treatment involves a combination of chemotherapy and other drugs – you’ll usually have two courses of chemotherapy in this phase of your treatment. The chemotherapy will be given to you by intravenous (IV) infusion, into a large vein in your arm via a long, flexible tube. There are two types of lines that may be used:
- a PICC line, which will go through a vein in your arm at the end of your elbow
- a central line (also known as a Hickman line), which will go through a vein under your skin on the upper part of your chest.
After you’ve finished remission induction therapy, you’ll start on consolidation therapy. The aim of this phase of treatment is to reduce your risk of relapse. Without consolidation therapy, there’s a higher risk of relapse in the year after your initial treatment.
During consolidation therapy, you’ll have more chemotherapy – usually one or two courses. You might also have a stem cell transplant. If you do have a transplant, you might not have any more chemotherapy after your remission induction treatment, or you just might just have one more course.
There are lots of different options for consolidation therapy, which are chosen on an individual basis. You’ll get to discuss this with your consultant.
Remission after intensive treatment
Your doctors will measure how well you’ve responded to treatment. During treatment you’ll have blood tests to see if your blood looks normal and if your blood cell count is normal. You’ll then have another bone marrow sample taken, to see if this looks normal too. You’ll have other genetic tests, similar to the ones you had when you were diagnosed, to look for any changes treatment has caused.
If your intensive treatment is a success, this is called remission. In remission, your bone marrow produces blood cells normally and you’ll have fewer than 5% of blast cells in your bone marrow. The DNA in your cells will also be back to normal.