How To Keep Your Acute Myeloid Leukemia From Coming Back: Explaining Consolidation Therapy

The goals of consolidation therapy ("post-remission therapy") are:

• To maintain remission
• To reduce the level of cancer even further

Even if doctors do not see evidence of cancer in the bone marrow, we know that it is still present at a low level because we cannot test every cell, and we need to keep giving cancer-directed therapy to prevent the leukemia from flaring up again.

“After somebody has received that initial round of chemotherapy for acute myeloid leukemia, most people will go into a remission, meaning as hard as we look we can’t find any of the leukemia left in the bone marrow,” Dr. Mikkael Sekeres, chief of hematology at Miami’s Sylvester Comprehensive Cancer Center, explained in a previous conversation with SurvivorNet. ” It doesn’t mean it’s gone. It just means that within the limits of our ability to detect it, we can’t see it. We know that there’s some of it still left. We give subsequent rounds of chemotherapy to try to mop up the remaining leukemia cells.”

Consolidation is also critical in making the cancer undetectable using advanced detection methods, which is known as being "MRD-negative" (measurable or minimal residual disease). MRD negativity is associated with better outcomes especially if your physician is planning a hematopoietic stem cell transplant (HSCT).

Preparing For A Stem Cell Transplant, While Finding A Matching Donor

The good news is that consolidation is less intense than induction therapy, so the side effects will be fewer, and the duration of treatment is shorter. With consolidation therapy:

• Sometimes, you do not even need to be admitted to the hospital to receive this treatment.
• Your physician will decide on how many cycles of consolidation you need, but most of the time it calls for 2-4 cycles depending on whether stem cell transplantation is planned afterwards.

There are many different chemotherapy regimens used for consolidation. You may hear a variety of acronyms being used, such as "HDAC" or "HiDAC," “LDAC," or "CPX-351/Vyxeos," or encounter complicated drug names such as gemtuzumab ozogamicin, azacitidine, decitabine, or venetoclax. Usually, a similar combination of drugs used during your induction therapy will be used for consolidation, but at a lower dose. Regardless of the drug used, the concept is the same to lower your cancer to the point of being able to undergo a stem cell transplant, or to the point of cure!

Sometimes physicians will refer to a stem cell transplant as a type of consolidation therapy. If planned, this generally occurs after several cycles of consolidation chemotherapy.

“When somebody has leukemia, that person has stem cells that have a defect in them that causes those growth of blasts. What we want do to with a bone marrow transplant is wipe out the bone marrow, all of those abnormal stem cells and abnormal leukemia cells, and replace it with a healthy bone marrow, with healthy stem cells that will grow a normal bone marrow,” Dr. Sekeres said in a previous conversation. “One of the advantages of a bone marrow transplant is we’re getting rid of the leukemia, giving whopping doses of chemotherapy, where if we did nothing else a person’s bone marrow would never recover, we rescue it with a healthy bone marrow that sets up shop and grows normal red blood cells, white blood cells, and platelets.”

Questions to Ask Your Doctor

• Do I need to undergo consolidation therapy as part of my treatment for AML?
• How is consolidation treatment different than induction treatment?
• What medications will I be given for consolidation treatment?
• How long will consolidation treatment last?
• Will I be able to have consolidation treatment as an outpatient?

Acute Myeloid Leukemia AMLAn Overview of Initial Treatment

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