Relapsed acute myeloid leukemia (AML) is when cancer returns after a period of remission. Refractory AML means cancer has not responded to multiple rounds of treatment. Both can affect your treatment options and outlook.
Acute myeloid leukemia (AML) is a type of blood cancer that begins in the bone marrow and primarily affects your white blood cells.
Prompt treatment is important to prevent AML from spreading to your lymph nodes and other parts of the body. The goal is to achieve cancer remission. In some instances, however, AML may transition to either a relapsed or refractory status.
What is the difference between relapsed and refractory AML?
If you have received treatment for AML , and a doctor says you have a relapsed or refractory subtype, this means the cancer is now in an active state. However, relapsed and refractory status are not the same thing.
Relapsed AML refers to a return of this cancer after a previous remission , an absence of cancer cells.
With relapsed AML, a complete blood count (CBC) may show new leukemia cells and lower levels of regular blood cells. If you experience this, your bone marrow will contain at least 5% abnormal white blood cells — also called blast cells .
Refractory AML, on the other hand, affects people who have not yet achieved remission. A doctor might diagnose you with refractory AML if you still have leukemia cells after undergoing two chemotherapy induction cycles.
When to contact a doctor
Contact a doctor right away if you suspect you may have recurring or worsening symptoms of AML . The most common of these include easy bleeding and bruising, weakness, and pain, which may develop within several days or weeks .
How does AML relapse affect your outlook and life expectancy?
The outlook for people with relapsed AML is generally unfavorable , though the exact statistics are still under investigation.
According to data from the National Cancer Institute, the 5-year relative survival rate for AML was 31.9% between 2014 and 2020.
However, it’s important to understand these statistics represent all cases of AML, and each person’s case is different.
One 2021 study of adults who experienced their first AML relapse after 5 years of remission found the median survival was 28.6 months . The researchers suggested more therapies may be needed for AML despite remission.
What is the outlook and survival rate for people with refractory AML?
The overall outlook for AML is mostly favorable in people who respond to initial induction treatments shortly after their initial diagnosis. Experts estimate that 2 in 3 people who receive induction chemotherapy achieve remission.
In people with cases of refractory AML where cancer remains active despite induction chemotherapy, the overall outlook remains less favorable compared with those who enter remission. However, like relapsed AML, the exact statistics are still under investigation as the outcomes are highly individual.
What are the treatment options for relapsed or refractory AML?
Treatment options for relapsed or refractory AML are similar.
One difference is a doctor might suggest genetic testing for relapsed subtypes to help determine the presence of genetic mutations after initial cancer remission. Their findings may help influence the use of certain targeted therapies for specific mutations, such as :
Other common treatments for relapsed and refractory subtypes include :
How can I prevent AML relapse?
To achieve remission, your bone marrow must have 5% blast cells or less, and your CBC levels must be within the normal range.
If you do enter AML remission, a doctor might recommend chemo consolidation, which involves additional chemotherapy to ensure the elimination of all leukemia cells. Experts estimate that about half of those who receive chemo consolidation achieve long-term remission.
However, it’s not always possible to prevent an AML relapse. Other factors that affect these chances are out of your control, such as your age, genetic mutations, and other health conditions.
Takeaway
Acute myeloid leukemia (AML) is a rapidly progressing cancer. Early diagnosis and treatment are crucial. Your age and overall health can affect your outlook with this type of leukemia, as well as whether you achieve remission after initial treatment.
If your AML is refractory — meaning it hasn’t responded to treatment — or has relapsed after prior remission, talk with an oncologist about your options.
While the outlook for people with these subtypes of AML may not be as favorable, treatments are available that may increase your lifespan and improve your overall quality of life.
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