Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Cancer Care

Fremont and San Leandro Medical Centers


Acute myelogenous leukemia (AML) is a cancer that involves immature white blood cells called myeloblasts. These myeloblasts are found in the bone marrow, the spongy tissue inside large bones where all blood cells are made.

The term “acute” means that the cancer can worsen quickly. Therefore, treatment for AML usually starts as soon as possible.

After we have learned everything we can about your leukemia, we will discuss the treatment options and develop a plan that is right for you. In AML, it is important to begin treatment immediately. AML is usually treated in 2 phases:

  • Induction: This first phase of therapy kills as many myeloblasts in the blood and bone marrow as possible with the goal of putting the cancer into remission. Remission means the blood and bone marrow contain no myeloblasts, the blood counts return to normal, and the signs and symptoms of AML go away.
  • Consolidation (postremission therapy): Once the leukemia is in remission, this second phase of treatment helps sustain the remission achieved during the induction phase.

Additional consolidation treatments may include further chemotherapy, bone marrow transplantation or other drug therapy.


The primary treatment for AML usually consists of chemotherapy drugs to kill the leukemia cells. Chemotherapy is usually delivered through the vein. In some cases, chemotherapy can be given as an injection or in pill form. Known as systemic chemotherapy, these drugs enter the bloodstream and attack leukemia cells throughout the body. The intensity of chemotherapy will depend on your age, health, and other factors.

To treat AML that has spread to the difficult-to-reach area, such as brain and spinal cord, chemotherapy drugs are injected directly into the spinal fluid.

Side effects

Chemotherapy can cause a variety of side effects, the severity of which depends on the type and dose of the drug as well as the length of time it is given. You may experience one or more of the following common side effects of chemotherapy:

  • Fatigue
  • Hair loss
  • Nausea and vomiting
  • Loss of appetite
  • Diarrhea
  • Mouth sores
  • Fatigue
  • Low blood cells counts
  • Fever

Chemotherapy can lower blood cell counts, a particular concern because it can increase the risk of infection. We may give you antibiotics to treat and prevent infections, injections to boost your white blood cell counts, and transfusions of red blood cells and platelets to boost your energy and prevent bleeding. We will monitor your blood work closely. You will likely stay in the hospital until your blood cell counts start to recover.

We have effective methods for managing the various chemotherapy side effects, which typically go away once treatment ends.

Bone Marrow Transplantation

In leukemia, the bone marrow (the place where blood cells are made) is filled with cancer cells. High doses of chemotherapy wipe out the bone marrow. After this chemotherapy, a matched bone marrow transplant from an appropriate donor, replaces blood-forming stem cells in the bone marrow, creating a healthy environment for blood cell production.

Stem cells are usually obtained from the circulating blood but may also come from a newborn’s umbilical cord and placenta, which are rich in blood stem cells. Depending on the source of the stem cells, there are two main types of transplant:

  • Allogeneic transplant: Blood stem cells come from a related or unrelated donor whose tissue type matches your tissue type. The closer the match, the better the chance your body will accept the donor stem cells and start producing normal blood cells.

Stem Cell Transplantation Side Effects

Treating the bone marrow with high-dose chemotherapy or radiation to prepare you for a stem cell transplant can temporarily leave your body without its natural defenses. It can take several weeks for the bone marrow to recover. During that time, you are at an increased risk of infection and bleeding.

A complication of allogeneic (donor) stem cell transplantation is graft-versus-host disease (GVHD). This happens when the donor stem cells recognize your body as foreign and start attacking tissues of the skin, digestive tract, and liver. Symptoms of GVHD include:

  • Skin rash or other skin changes
  • Yellowing of the skin and eyes
  • Nausea
  • Diarrhea
  • Fatigue and weakness

We will talk with you about what side effects to expect, and how we plan to prevent and manage them.

Other Drug Therapy

Treatment for a subtype of AML called acute promyelocytic leukemia (APL) differs from treatment for other AML subtypes. APL is particularly vulnerable to the effects of a drug called all-trans retinoic acid, or ATRA, which is a form of vitamin A. ATRA, also known as tretinoin, often accompanies chemotherapy as initial treatment for APL, and you will likely continue to receive ATRA for 1 to 2 years.

Another drug called arsenic trioxide may be used in combination with ATRA. Arsenic trioxide may also be given alone to treat APL that returns after treatment with ATRA plus chemotherapy.

Side effects

ATRA can have the same side effects as taking too much vitamin A. You may experience:

  • Headache.
  • Stuffy nose.
  • Dry skin or a skin rash.
  • Chapped lips or mouth sores.
  • Fever.
  • Swollen feet.
  • Eye irritation.

Side effects of arsenic trioxide may include:

  • Fatigue.
  • Nausea and vomiting.
  • Diarrhea.
  • Numbness and tingling in the hands and feet caused by nerve damage.
  • Heart rhythm abnormalities.

We may check your heart regularly while you receive arsenic trioxide to detect any changes. Side effects often go away once treatment ends, but it is important to let us know if you experience any of these symptoms so that we can treat them.

Another possible side effect of both ATRA and arsenic trioxide is differentiation syndrome, also known as retinoid acid syndrome. Problems associated with differentiation syndrome include:

  • Breathing difficulties caused by fluid buildup in the lungs and around the heart.
  • Swelling of the legs and feet caused by fluid buildup.
  • Low blood pressure.
  • Kidney damage.
  • Fever.

The syndrome occurs in about 1 in 4 patients within the first 3 weeks of starting treatment. The steroid dexamethasone is an effective treatment for differentiation syndrome, so we will watch you closely for signs of the syndrome.

Clinical Trials

We are always looking for new and better ways to treat AML. Clinical trials are research studies that test new treatments or procedures that may prove better than standard treatments. We will talk with you about whether a clinical trial may be right for you.

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