Leukemia--Acute Myeloid (Myelogenous) Overview

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Treating Leukemia - Acute Myeloid (AML) TOPICS

What if the acute myeloid 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 or stronger doses of chemotherapy (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. 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.

For acute promyelocytic leukemia

Most patients with acute promyelocytic leukemia (APL) are treated with ATRA plus chemo and do well. If the leukemia doesn’t respond to the first treatment with ATRA or it comes back (relapses), a drug called arsenic trioxide (Trisenox) often works well in bringing about a second remission. A stem cell transplant may be another option if a donor can be found.

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.

Last Medical Review: 06/27/2013
Last Revised: 02/07/2014