Acute Myeloid Leukemia: Therapy

General measures

• Nicotine restriction (refraining from tobacco use).
• Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
• Normal weight to strive for or maintain!Determination of BMI (body mass index, body mass index) or body composition using electrical impedance analysis.
  • BMI ≥ 25 → participation in a medically supervised weight loss program.
  • Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
• Avoidance of environmental stress:
  • Radiation exposure, especially in combination with the administration of alkylants (cytostatics).
  • Benzene
  • Exposure to petroleum products, paints, ethylene oxide.
  • Formaldehyde
  • Herbicides (weed killers)
  • Pesticides (pesticides)

Conventional non-surgical therapy methods

Allogeneic stem cell transplantation (more precisely, hematopoietic stem cell transplantation; HSCT; hematopoietic stem cell transplantation) is performed after chemotherapy and subsequent radiotherapy when there is a clearly increased risk of recurrence or when recurrence occurs. The patient should be free of infection and in a general condition that allows intensive therapy. Further notes

• The probability of being leukemia-free five and 10 years after stem cell transplantation was 86% and 76%, respectively, in a long-term study. The 5-year cumulative incidence of recurrence was 11% and finally 16% after ten years.
• Patients who tested positive for multidrug-resistant germs before allogeneic stem cell transplantation were less likely to survive five years later (43.3% versus 65.5%).

Vaccinations

The following vaccinations are advised before starting therapy:

• Influenza vaccination (seasonal quadrivalent inactivated vaccine).
• Pneumococcal vaccination: immunocompromised individuals should be vaccinated sequentially with the 13-valent conjugate vaccine PCV13 and six to 12 months later with the 23-valent polysaccharide vaccine PPSV23 against pneumococcus.
• Meningococcal vaccination (ACWY and B).
• Herpes zoster vaccination (only with inactivated vaccine.
• If necessary, booster vaccination against diphtheria, Haemophilus influenzae capsule type b (Hib), pertussis and tetanus.

Regular checkups

• Regular follow-up examinations for early detection of relapse (recurrence of the disease): regular clinical presentations, as well as blood count and bone marrow checks; bone marrow examination must be performed if there is clinical suspicion of relapse or abnormal blood count.
• Blood count checks every 1-3 months within the first two years, then every 3-6 months for years 3-5.

Nutritional medicine

• Nutritional counseling based on nutritional analysis
• Nutritional recommendations according to a mixed diet, taking into account the general knowledge of nutrition in a tumor disease. This means:
  • Consume only limited energy-rich foods.
  • Moderate total fat intake
  • Little red meat (pork, beef, lamb, veal) and sausages.
  • Once or twice a week fresh sea fish, ie fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
  • High-fiber diet (whole grains, vegetables).
  • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
  • Reduce consumption of smoked and cured foods, because they contain nitrate or nitrite as a component of curing salt. Their preparation produces compounds (nitrosamines), which are risk factors for various tumor diseases.
  • Refrain from polluted foods such as offal and wild mushrooms.
  • Do not eat moldy food
• Observe the following special dietary recommendations:
  • Diet rich in:
    • Vitamins (A, C, D, E, folic acid).
    • Minerals
    • Trace elements (selenium, zinc)
    • Omega-3 fatty acids
    • Secondary plant compounds (e.g. carotenoids, polyphenols).
• Selection of suitable food based on the nutritional analysis
• See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
• Detailed information on nutritional medicine you will receive from us.

Sports Medicine

• Endurance training (cardio training).
  • Sufficient physical activity means ≥ 150 min/week of moderate physical activity or ≥ 75 min/week of intense physical activity.
  • • Moderate physical activity: Playing badminton, golfing, leisurely cycling, skiing, swimming, dancing, playing tennis (doubles), playing volleyball, brisk walking/hiking without baggage, mowing the lawn, climbing stairs, carrying light loads, and doing moderately heavy household, gardening, and repair work.
    • Intense physical activities: Playing basketball, playing soccer, running, jogging, playing tennis (single game), brisk cycling, hiking with luggage, mountain climbing, heavy gardening, as well as carrying heavy loads.
  • In general, endurance training on a bicycle ergometer can be recommended, which is performed according to the principle of interval training. This means that load phases of 1 to 3 minutes duration alternate with rest phases of also 1 to 3 minutes duration. The training should be performed at about 80% of the maximum heart rate for a total of 30 minutes.
• Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
• Detailed information on sports medicine you will receive from us.

Psychotherapy

• Psychosocial care
• Detailed information on psychosomatic care (including stress management) is available from us.

Complementary treatment methods

• Pain therapy