What if the leukemia doesn`t respond or comes back after treatment?

For most types of acute myeloid leukemia

If acute myeloid leukemia (AML) doesn't go away with the first treatment, newer drugs or more intensive doses of chemotherapy drugs may be tried, if they can be tolerated. A stem cell transplant may be tried in younger patients if a suitable stem cell donor can be found. Clinical trials of new treatment approaches may also be an option.

If the leukemia went away and has now come back, the treatment options may depend on the patient's age and health, and on how long the leukemia was in remission. AML most often recurs in the bone marrow and blood. The brain or cerebrospinal fluid (CSF) rarely will be the first place it recurs, but if it does, it is treated with chemotherapy given directly into the CSF.

For those whose remission lasted longer than 6 months, it is sometimes possible to put the leukemia into remission again with more chemotherapy, although this is not likely to be long-lasting. For younger patients (generally those younger than 60), most doctors would then advise a stem cell transplant if a suitable donor can be found. Clinical trials of new treatment approaches may also be considered.

If AML comes back sooner than 6 months, most doctors will advise a stem cell transplant for younger patients, if possible. Taking part in a clinical trial is another option.

If the leukemia keeps coming back or doesn't go away, further chemotherapy treatment will probably not be very helpful. If a stem cell transplant is not an option, a patient may want to consider taking part in a clinical trial of newer treatments.

For acute promyelocytic leukemia

For the 20% to 30% of patients with acute promyelocytic leukemia (APL) who don't respond to initial treatment or who relapse, arsenic trioxide (Trisenox) is often very effective. A stem cell transplant may be another option if a donor can be found.

If treatment with arsenic trioxide achieves a remission, further courses of this drug may be given. An autologous stem cell transplant may also be an option. If a second remission is not achieved, treatment options may include an allogeneic stem cell transplant or taking part in a clinical trial.

Palliative treatment

If a clinical trial is not an option, it is important at this time to focus on relieving the symptoms of the leukemia. This is known as palliative treatment. For example, the doctor may advise less intensive chemotherapy with the goal of slowing the leukemia growth instead of trying to cure it.

As the leukemia grows in the bone marrow it may cause pain. It is important that you be as comfortable as possible. Treatments that may be helpful include radiation and appropriate pain-relieving medicines. If medicines such as aspirin and ibuprofen don't help with the pain, stronger opioid medicines such as morphine are likely to be helpful.

Other common symptoms from leukemia are low blood counts and fatigue. Medicines or blood transfusions may be needed to help correct these problems. Nausea and loss of appetite can be treated with medicines and high-calorie food supplements. Infections that occur may be treated with antibiotics.