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

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

If the disease comes back after treatment it will most often be in the bone marrow and blood. Rarely the brain or spinal fluid will be the first place it is seen. This would be treated with chemo given right into the spinal fluid. If the leukemia went away and has come back, another remission might be possible, but most doctors think it would be only short-term. They might suggest a stem cell transplant in this case.

For fairly small percentage of patients with acute promyelocytic leukemia (APL) who don't respond to the first treatment with ATRA or who have the cancer come back (relapse), a drug called arsenic trioxide (Trisenox) often works well in bringing about a second remission. The most serious possible side effect of this drug is a change in heart rhythm. A stem cell transplant may be another option if a donor can be found.

If the leukemia keeps coming back or doesn't go away, chemo will not be very helpful. If a stem cell transplant is not an option, taking part in a clinical trial might be a good idea.

Palliative treatment

If a clinical trial is not an option, then it may be time to focus on relieving symptoms rather than curing the cancer. This is known as palliative treatment. The doctor may suggest milder chemo to slow the growth of the leukemia and reduce symptoms.

If there is pain, then it's important to treat it with pain killing medicines. Sometimes medicines or blood transfusions are needed to correct low blood counts and tiredness. Nausea and loss of appetite may be helped by high-calorie food supplements and medicines. Antibiotics may be needed to treat infection.