What is induction therapy?

What is induction therapy? Induction therapy is the term that's used for intensive chemotherapy. You may also hear it called 7 plus 3. The standard treatment is citerabine with a second agent, either Donna Rubison or Ida Rubison, generally speaking. And this is traditional induction chemotherapy that we give to younger patients. Again, for older individuals who can't tolerate this very intensive type of chemotherapy, we generally use a hypomethylating agent like the cytobine or azacytidine, often with venetoclax or with another targeted agent. So induction therapy for AML is the first step of treatment. When somebody is first diagnosed with acute myeloid leukemia, they're either usually in the hospital or seeing somebody in clinic. And the therapy overall can be thought of in a couple different steps. Induction therapy is the first step. And the way I like to think about it is induction therapy is kind of like if you have a garden that's overrun with weeds and you're trying to get all those weeds out and get everything to all the flowers to grow back, that induction therapy is kind of like cutting the tops off the weeds. It really kind of drives the leukemia out that we can see in the body. And at the same time, it doesn't do so to such a low level like pulling up the roots where you can't, where everything's going to grow back forever and in the future. It kind of is that first step of kind of getting rid of the leukemia that's really causing the big issue with the blood counts. And then with induction therapy, you're trying to make sure that you can get somebody into a first remission. And so you're trying to really just tamp down the burden of the disease that's circulating everywhere in the body and get it so that some of the good cells that are kind of the flowers in the garden, get those to kind of start coming back. And so the whole thing with induction therapy is that we give it over the first several days depending on what the therapy is. And then the next usually 28 to 40 days are kind of making sure that we are supporting the patient in terms of being able to get through it and feel as well as possible in that their blood counts are going to go down. That puts them at risk for infection, for bleeding, and just makes them generally pretty tired. We'll give induction therapy and then we will basically watch the patient daily and make sure that we can give them blood products as necessary, antibiotics, and the Tylenol and those kind of things to make sure that they can feel as good as possible because you'll get the therapy and then all the counts will go down over the next two weeks or so and then we kind of wait for them and the flowers to kind of start to come back. And at the end of it, then we do a biopsy to kind of see if people are in remission. At that time, we know that we've cut off those tops of the weeds and that we've kind of made a good progress but we know to kind of get to long-term remission, we need to go after the roots and pull them up and those kind of things are the next steps which either might be more chemotherapy or transplant.