Refractory and Relapsed
Most patients achieve a remission (an absence of signs and symptoms) after initial treatment for acute myeloid leukemia (AML). In some patients, however, the leukemia cells resist treatment. This is referred to as refractory leukemia. For refractory AML, treatment options may include:
- drugs not already used during your past treatment
- conditioning therapy followed by an allogeneic stem cell transplantation
Some patients have a return of AML cells in the marrow and a decrease in normal blood cells after remission. This is called a relapse. If you have relapsed AML, you may be given more chemotherapy with the same or different drugs used previously during your treatment. Some patients may also have a stem cell transplantation.
Your therapy options depend on two factors:
- your remission's duration
- the cytogenetic findings that reveal abnormal changes to the structure of your chromosomes in your leukemia cells
Stem Cell Transplantation in Relapsed Patients
Your doctor may suggest some form of allogeneic stem cell transplantation if you're in early first relapse or second remission. If you don't have a brother or sister who can donate stem cells, a matched-unrelated donor transplant can be effective. However, this is a high-risk procedure.
If you relapse after allogeneic stem cell transplantation, you may be treated with a donor leukocyte infusion (DLI).This therapy involves giving lymphocytes taken from the original stem cell donor to the patient with a disease relapse after a transplant. DLI can induce an immune reaction against your cancer cells and help bring about remission. DLI has been most effective in patients with chronic myeloid leukemia who relapse after transplantation, but researchers are studying it for use in treating patients with AML and other blood cancers.
You and your doctor may decide that the best treatment route for you is one being studied in a clinical trial. Several drugs and drug combinations used to treat AML are currently being studied.