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 reach remission and then have a return of AML cells in the marrow and a decrease in normal blood cells. This is called a relapse. For relapsed AML, you may be given more chemotherapy with the same or different drugs used previously during initial treatment. Some patients may also have a stem cell transplantation.
Treatment options depend on two factors:
- The remission's duration
- The cytogenetic test results that show abnormal changes to the structure of chromosomes in the leukemia cells
Stem Cell Transplantation in Relapsed Patients
Allogeneic stem cell transplantation may be a treatment option for patients in early first relapse or second remission.
If you relapse after allogeneic stem cell transplantation, you may be treated with a donor leukocyte infusion (DLI).This therapy involves taking lymphocytes from the original stem cell donor and giving them to the patient who relapsed after 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.
For some patients with relapsed or refractory AML, the best treatment route may be one that is being studied in a clinical trial. Several drugs and drug combinations used to treat AML are currently being studied.