Acute myeloid leukemia (AML) is a difficult blood cancer to cure. But new therapies often put the disease into remission. When you’re in remission, tests show few (if any) leukemia cells in your bone marrow or blood, and you don’t have any symptoms or evidence of disease. Remission is the closest thing doctors have to a cure for AML.

What is the AML “cure” rate?

The prognosis for most people with AML is favorable. Approximately 2 out of 3 people with AML go into remission after getting chemotherapy (the first phase of AML treatment). The second phase of treatment (post-remission therapy) puts up to half of people with AML into remission. Some people never develop the disease again.

While these numbers are hopeful, remission doesn’t always last. When cancer comes back, it’s called a relapse.

What causes AML relapse?

AML relapse may occur for a number of reasons:

• AML failed to respond to initial treatments

• tests didn’t detect a small number of lingering leukemia cells in the blood, and those cells are now actively multiplying

• leukemia cells in the blood have spread (metastasized) to other parts of your body

What are the symptoms of AML relapse?

Your body may tell you when cancer returns. You may start to feel the same way you did when you received the initial cancer diagnosis.

AML symptoms are easy to dismiss. In fact, you may not have given much thought to your symptoms the first time you were sick. Once you’re more familiar with AML symptoms, it’s important to pay attention to changes and contact your doctor if you start feeling unwell.

AML typically returns in bone marrow and blood, causing the same symptoms as before:

• bone or joint pain

• easy bruising or bleeding

• extreme fatigue

• fever

• loss of appetite and weight loss

• night sweats

How is AML relapse diagnosed?

You're more likely to experience a cancer relapse while in the second phase of treatment or shortly after finishing treatments. Rarely, AML returns after you’ve been in remission for several years. It’s important to catch AML relapse early so you can start treatments quickly when they’re more effective.

Even when you feel healthier and have no signs of cancer, you’ll still need frequent follow-up tests to check for cancer relapse. For the first year or two after you finish treatments, your doctor may require monthly blood tests or bone marrow tests. These tests are the same ones you had when first diagnosed with AML. After a few years have passed with no signs of disease, your doctor may approve annual blood work.

If blood or bone marrow tests indicate a relapse, you may get imaging tests. CT or MRI scans can show whether cancer has spread to other parts of the body. AML is a fast-growing cancer that can quickly spread to:

• brain

• lymph nodes

• liver

• spinal cord 

• spleen

• testicles (in men)

From the community: “My daughter was diagnosed with AML ... She has undergone chemo and bmt and has had few days without pain, vomiting etc. Even though she has been in and out of remission, according to the doctors, we could not tell the difference by the way she has felt. Now she has relapsed again. She needs Chemo, but her white blood cells are too low, they are trying to build them up, but she has a blood clot in her lung that they are trying to dissolve… I am praying for answers to her dilemma, and searching the internet for more knowledge on the subject, but I don't understand it well enough to be sure what could be helpful. If anyone has had experience with similar problems I would like to hear from you.” – Inspire member

What factors affect AML relapse treatments?

When cancer returns, your doctor will consider several factors when developing a treatment plan. Factors that influence treatment success include:

• age (people younger than 60 fare better with certain treatments after relapse)

• cancer subtype

• genetic or chromosomal changes in leukemia cells

• number of years of cancer remission

• overall health

How is AML relapse treated?

Treatments for relapsed AML include:

• Chemotherapy: The same initial treatment that put AML into remission the first time may put it into remission again. However, remission time is likely to be short. Over time, AML cells can stop responding (become resistant) to chemotherapy. 

• Targeted therapies: These drugs disrupt specific characteristics within cancer cells to stop their growth. They can be effective on AML caused by a known chromosomal or genetic change (mutation). Targeted therapies for AML include gemtuzumab ozogamicin (Mylotarg®), gilteritinib (Xospata®), ivosidenib (TIBSOVO®), and enasidenib (IDHIFA®).

• Treatment trials: If chemotherapy no longer works, you can look into trials. As a participant in a trial treatment, you have the chance to try new therapies that are still in development. 

What’s the prognosis for people with AML who relapse?

The longer you’re in remission, the better your chances of responding well to follow-up treatments for AML relapse. In general, AML that returns, or relapses, is more difficult to treat. As a result, the prognosis isn’t as favorable.

Studies show that people who are in complete remission for more than two years have a 73% positive response rate to treatments for AML relapse. That success rate drops to 47% if the cancer returns within 1 to 2 years after initial treatment, and to 14% if cancer returns in less than one year.

What steps can enhance quality of life?

A cancer relapse is stressful. These actions can help you cope:

• Connect with members of the Inspire Leukemia Support Community.

• Get palliative care for side effects and symptoms, such as fatigue and nausea.

• Join an online or in-person support group.

• Talk to a mental health professional.

• Consult with a dietitian to manage treatment side effects like loss of appetite and nausea.

From the community: “My husband was diagnosed with AML … and had "standard" 7+3 induction chemo which put him into remission... It seemed he was doing great with mild GVHD until a few weeks ago he was suffering from sharp pain shooting down his leg. At first he thought he pulled a muscle from running and when it didn’t seem to get any better more tests led to the devastating news last week that the AML is back with 50% blasts!!! We are still in shock and very scared.” – Inspire member

Sources

• If Acute Myeloid Leukemia (AML) Doesn’t Respond or Comes Back After Treatment. American Cancer Society. August 2018.

• Living as an Acute Myeloid Leukemia (AML) Survivor. American Cancer Society. August 2018.

• What Is Cancer Recurrence. American Cancer Society. February 2016.

• Relapsed and Refractory. Leukemia and Lymphoma Society. 

• Acute Myeloid Leukemia (AML) Treatment and Management. Medscape. May 2020.

Disclaimer

Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.