Azacitidine for Acute Myeloid Leukaemia (AML)

In this blog, we look at azacitidine for acute myeloid leukaemia (AML), what it is, common side effects and more.

What is azacitidine?

Azacitidine is an antimetabolite drug that interferes with the formation of DNA, with the result of preventing the reproduction of cells in the body, particularly cancer cells which are multiplying at a greater rate than normal cells.

Azacitidine is approved for the treatment of adult patients under the age of 65 years who are not eligible for a bone marrow stem cell transplant (SCT) with the following specific types of AML or AML-related conditions:

  • AML with 20% to 30% marrow blasts in the bone marrow
  • Intermediate- to high-risk myelodysplastic syndromes (MDS)
  • Chronic myelomonocytic leukaemia (CMML) with 10% to 19% marrow blasts that is of ‘dysplastic disease subtype.’

Method of administration:

Azacitidine Celgene is available as a 25mg/ml powder to be suspended ready for injection. The recommended dose is 75mg/m2 of body surface area, once a day for seven days, followed by a rest period of 21 days (totalling a treatment cycle of 28 days). It is administrated subcutaneously, under the skin of the upper arm, thigh or stomach. Sometimes it will be given on seven consecutive days, but most haematology day units will administer it on weekdays only (i.e. skipping the weekend; sometimes referred to as ‘5+2+2’).

Treatment should be given for at least six cycles and then for as long as it is of benefit to you. This will depend on the leukaemia or MDS type you have. You should talk to your consultant or nurse if you have any queries about the length of treatment you are receiving.

You will have blood tests before each cycle of treatment to monitor your blood cell counts, liver and kidneys. If your blood counts become too low or the kidney tests are not satisfactory, your next treatment cycle may be delayed or your dose of azacitidine may be adjusted.

As it can be administered subcutaneously, you can usually receive azacitidine as an outpatient, meaning you will be able to go home after each treatment session.

Occasionally your doctor may adjust your dose of azacitidine or may delay your treatment for a short while. This may be because of the effects of the azacitidine on your body or on the cancer itself.

Common side effects:

  • Nausea and vomiting, abdominal pain, diarrhoea or constipation.
  • Anaemia due to low red blood cell levels.
  • Increased risk of infection due to low levels of the white blood cells which fight infection.
  • Fatigue
  • Headaches or dizziness
  • Aching or pain in joints or muscles
  • Shortness of breath
  • Inflammation of the skin or veins at the injection site
  • Insomnia
  • Inflammation of the nose and/or throat
  • Loss of appetite or weight loss
  • Pins and needles, or a tingling feeling in your fingers and toes

Uncommon side effects:

  • Hypertension or hypotension
  • Bone marrow failure
  • Allergic reactions
  • Bruising or bleeding due to low platelet levels, the type of blood cell which helps to stop bleeding.
  • Bleeding into the brain may make you drowsy, tired out or faint.
  • Lung or heart problems tend to occur if you have existing lung or heart problems.
  • Changes in kidney and lung functions.
  • Hair loss.
  • Dehydration.
  • Confusion and anxiety.
  • Indigestion.
  • Changes to your skin.

Who was involved in the production of the booklet?

This booklet has been updated by our Patient Information Writer, Isabelle Leach, and peer reviewed by Dr Steve Knapper. We are also grateful to leukaemia patients Sue Chambers, Anne Taylor and Nigel Lilburn for their valuable contributions as patient reviewers.

If you would like more information about azacitidine as a treatment for AML, you can download the booklet from our information booklets page here.

Download our Azacitidine for Acute Myeloid Leukaemia (AML) booklet

Our Azacitidine for Acute Myeloid Leukaemia (AML) booklet provides more information on this type treatment for AML patients.

Download our information booklet