Acute Myeloid Leukemia (AML) Treatment: How Is It Managed in 2026?

Acute myeloid leukemia is treated by starting induction chemotherapy immediately upon diagnosis, then either adding consolidation chemotherapy or moving to allogeneic hematopoietic stem cell transplantation depending on risk group. Which subtype and risk group a patient falls into is the most important factor determining whether transplantation is needed.

Key Takeaways

• Acute leukemia requires treatment to start immediately upon diagnosis. Induction chemotherapy is the first step, and hospitalization of about 4–6 weeks is typical.
• Once remission is achieved, treatment moves either to consolidation chemotherapy or to allogeneic hematopoietic stem cell transplantation, depending on risk group.
• Depending on the subtype, targeted agents matched to genetic targets such as FLT3, NPM1, and IDH may be added to chemotherapy.
• Korea's 5-year relative survival rate for leukemia is 55.7% (National Cancer Registration Statistics 2019–2023, National Cancer Information Center). This is a nationwide statistic, not the outcome of any single hospital.
• Allogeneic transplant requires a donor. Donors are sought in the order of siblings, haploidentical donors (parent/child), unrelated donors, and cord blood, and Korea has accumulated substantial experience with haploidentical transplants.

What tests are used for diagnosis, and how is risk group determined?

• Bone marrow examination—obtaining marrow fluid and tissue from the pelvic bone—is central to diagnosis. This includes morphologic review of cell shape, flow cytometry for surface markers, chromosome (cytogenetic) testing, and genetic testing for markers such as FLT3, NPM1, IDH, BCR-ABL, and TP53.
• These results determine the subtype and classify the case into low, intermediate, or high risk group, which is the basis for deciding whether chemotherapy alone or transplantation is needed.
• Before starting treatment, heart, lung, liver, and kidney function are checked, along with hepatitis B and C, HIV, tuberculosis, and cytomegalovirus infection status. Because blood cancer treatment substantially suppresses immunity, these tests are part of the treatment planning. If transplantation is being considered, HLA tissue-matching tests for the patient and family members are also performed.

What is the treatment sequence?

• Step 1 — Induction chemotherapy eliminates cancer cells in the bone marrow. This phase typically requires 4–6 weeks of hospitalization.
• Step 2 — Once remission is achieved, treatment proceeds either to consolidation chemotherapy or to allogeneic hematopoietic stem cell transplantation depending on risk group. Targeted agents may be added to chemotherapy depending on subtype, and for certain subtypes, a drug other than conventional chemotherapy may become the main treatment.
• Step 3 (if transplantation is needed) — Donors are sought in the order of siblings, haploidentical donors such as parent/child, unrelated donors, and cord blood. After about one week of conditioning chemotherapy, hematopoietic stem cells are infused intravenously, and engraftment typically takes 2–4 weeks.
• Step 4 — After engraftment is confirmed and the patient's condition stabilizes, discharge follows, but the patient stays within walking distance of the hospital and attends outpatient visits frequently. Because of graft-versus-host disease and infection management, allogeneic transplant care is often planned around the 100-day mark after transplant.

What side effects and recovery can be expected during treatment?

• After high-intensity chemotherapy or transplantation, a period of near-zero white blood cell count lasting days to weeks follows. During this time, fever and infection are the greatest risks, so patients stay in a sterile ward and are managed with antibiotics and transfusions. Mouth sores, nausea, diarrhea, hair loss, and severe fatigue are common.
• A complication unique to allogeneic transplant is graft-versus-host disease, in which the donor's immune cells attack the patient's skin, gut, liver, eyes, and mouth. It can appear acutely early on or develop into a chronic form over months, requiring immunosuppressant medication and frequent outpatient visits up to around the 100-day mark.
• Immune recovery can take several months to over a year, meaning a long period during which vaccinations must be redone and infection precautions maintained. If fever of 38°C or higher or chills occur, patients should contact their medical team immediately or go to an emergency room.

How is follow-up monitoring done after remission?

• After remission, blood tests and bone marrow tests are repeated at set intervals to check for minimal residual disease, and these results can change subsequent treatment decisions.
• For patients who received allogeneic transplant, long-term monitoring covers not only relapse surveillance but also graft-versus-host disease, infection, bone density, and secondary cancers that may arise later. Patients can request a handover document listing the schedule and items for future tests along with immunosuppressant dosing, so that local medical staff can take over care after returning home.

FAQ — What if there is no matching donor?

Even without a fully matched sibling, options remain. Haploidentical transplant from a parent, child, or sibling, unrelated donor searches, and cord blood are alternatives. Korea's accumulated experience with haploidentical transplantation helps reduce cases where treatment is delayed due to failure to find a donor.

FAQ — With acute leukemia, is there time to travel for treatment?

Since acute leukemia requires treatment to begin immediately upon diagnosis, patients often receive induction chemotherapy first and consider traveling at the stage when transplantation becomes necessary. Whether travel is safe can be assessed together during the pre-treatment remote review (pre-arrival review) stage.

Sources and Notes

• This article was written based on principle notes on blood cancer, hematopoietic stem cell transplantation, targeted therapy, and chemotherapy side-effect management (National Cancer Information Center, National Cancer Registration Statistics 2019–2023, NCCN patient guidelines, SEER).
• This content is provided for general medical information purposes, and actual diagnosis, treatment methods, and outcomes may vary depending on individual condition. Accurate diagnosis and treatment should always be determined through consultation with medical professionals.