A person living with acute myeloid leukemia (AML) achieves remission when treatment successfully removes most of the leukemia blast cells from the bone marrow and blood. This is the goal of treatment.
Doctors measure AML remission by the number of months or years that leukemia does not return. Factors that can affect remission include the person’s age, the type of AML, and whether certain genes or chromosome changes are present in the leukemia cells.
Remission may involve further treatment, known as consolidation, to remove as many blast cells as possible. After a period of remission, AML can return. Postremission therapy may be necessary to reduce the risk of relapse and improve survival rates.
This article will explain what remission means for a person with AML and provide information on survival rates for the condition.
A person living with AML is in remission when their bone marrow contains
AML remission depends on several factors, including:
- the type of AML
- the person’s age
- other preexisting health conditions
- how well and quickly a person responds to AML treatment
- chromosomal changes to the genes
Tests
Around
Age can be a factor in achieving remission. About
People who go into remission from standard therapy may also receive consolidation chemotherapy to remove any remaining leukemia cells. Nearly half of people who receive consolidation chemotherapy will achieve long-term remission.
Certain types of chromosomal abnormality
If a person with AML does not go into remission with standard induction chemotherapy, a doctor may recommend a
For people who may not tolerate regular treatment, doctors may recommend lower-intensity combination chemotherapy to manage symptoms. AML may be more resistant and side effects more intense in older adults.
When AML does not respond to standard chemotherapy, a doctor may recommend other options, including:
- a stem cell transplant
- targeted therapy for specific gene mutations
- clinical trials for new treatments
- additional chemotherapy, called reinduction
Doctors are more likely to offer stem cell transplants to fit and otherwise healthy people, including younger patients, either from a donor or their own stem cells. Stem cell transplants carry risks but can also offer success for cancer remission.
If a person living with AML has not responded well to treatment, a doctor may suggest joining a clinical trial of investigational therapies.
The 5-year survival rate measures the percentage of people who live at least 5 years after a cancer diagnosis. It is important to remember that 5-year survival rates are only averages. A person’s specific prognosis depends on:
- age
- overall health
- subtype or classification and stage of AML
- how the person responds to treatment
genetic profile
Survival rates and age
AML prognosis is different for adults, children, and teens.
People over the age of 20 with AML have an
For people aged 0–19, the average 5-year survival rate is 68%. This means 68 out of 100 children diagnosed with AML are still living 5 years from the time of diagnosis.
Little information is available about AML survival rates for every type and age group. Overall, AML that reaches advanced stages and has spread to new locations is more difficult to treat.
To estimate survival rates, cancer experts look at large numbers of people with AML. It is important to remember each case and person is different. Many factors can alter the way AML progresses and how a person responds to treatment. Also, current 5-year survival rates rely on data from at least 5 years ago. A person’s outlook could be better than estimated, considering possible new advances in AML treatment.
Outcomes in childhood AML
An ongoing study quoted by the
The study also found it was rare to find two children living with genetically similar cancers. Treatment is most effective when it targets each individual’s cancer.
Research on AML treatment options is an ever-growing subject. Survival rates are constantly improving thanks to advances in medical research.
People who achieve remission from the first round of induction chemotherapy may go on to postremission therapy. Postremission therapy aims to remove residual leukemia blast cells, reduce the risk of relapse, and improve survival rates.
Doctors may recommend maintenance therapies depending on the type of AML and the person’s response to treatment. Postremission treatments may include:
- Observation without maintenance therapy: Scientists also use this as a control arm of a study.
- Cytotoxic chemotherapy maintenance: Studies have found it difficult to prove that this therapy offers a survival benefit.
- Hypomethylating agents maintenance: In studies, the use of azacitidine and decitabine have shown promising results.
- Immunotherapies maintenance: Immunotherapy research is ongoing. Statistically significant, large-scale studies have not pinpointed an effective therapy for use.
- Targeted therapy maintenance: Certain types of AML may respond well to targeted therapy. Targeted therapy with FLT3 inhibitors has shown promise. Some studies have shown improved outcomes.
- Post-allogenic stem cell transplant maintenance therapy: People who receive an allogenic stem cell transplant have a high risk of relapsing after the treatment.
More research is needed into maintenance therapy, taking the quality of life for people living with AML into account.
Staging for leukemia is different from other types of cancer. Instead of traditional cancer staging involving tumor size and location, doctors use a classification system for AML.
They rely on
FAB AML classification
This system divides AML into eight subtypes, from M0–M7, based on several factors, including:
- the type of cell where leukemia began
- the number of healthy blood cells present
- the number, size, and maturity of leukemia cells present
- changes in the leukemia cells’ chromosomes
- other genetic abnormalities, including gene mutations
WHO AML classification
In 2016, the WHO updated its AML classification system to account for factors affecting the outlook. It divides AML into several groups:
- AML featuring certain genetic abnormalities, including changes to chromosomes and genes
- AML featuring myelodysplasia-related changes
- AML occurring after previous radiation or chemotherapy treatments
- AML that does not fit any one of the above groups
WHO classification also includes:
- myeloid proliferation relating to Down syndrome
- myeloid or granulocytic sarcoma, a rare malignant tumor
undifferentiated and biphenotypic acute leukemias or mixed phenotype acute leukemias – not strictly AML, but with lymphocytic and myeloid features
A person living with AML may go into remission when treatment successfully removes most leukemia blast cells. They may have no sign of disease or have residual disease, which can cause relapse. Remission may involve further treatment, known as consolidation, to remove as many blast cells as possible and lower the risk of relapse. Children with AML are more likely to have successful treatment.
The earlier doctors find AML, the more effective treatment will be, and the better the chances of a good outlook. Treatment for AML continues to improve both quality and length of life for people living with the condition. Treatment advances and targeted therapies are showing promise, and the 5-year survival rate for adults is improving.