Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. It is a fast growing cancer that can be difficult to treat.

Some people with AML may respond well to treatment initially but then experience a relapse, which is when cancer cells return. Doctors may need to carry out additional tests to check whether the leukemia cells have the same mutations as those in the first diagnosis. These tests help doctors recommend the best treatment options.

This article will explain what it means to have relapsed AML. It will also discuss the tests that doctors may perform and the available treatment options.

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A relapse is when a disease returns after it has previously gone into remission. Remission occurs when treatment is successful, and the person no longer has any signs or symptoms of the disease.

Relapsed vs. refractory AML

The Leukemia & Lymphoma Society (LLS) notes that most people with AML achieve remission after first receiving treatment. However, other people may still have residual cancer cells that persist after AML treatment. If someone does not reach remission after two cycles of chemotherapy, doctors refer to their condition as refractory AML.

Relapsed AML occurs when cancer cells return after a person has achieved remission.


Relapse is common among people with AML. According to a 2019 study in the Blood Cancer Journal, approximately two-thirds of people with AML relapse after their initial treatment. The likelihood of relapse varies among age groups, with 40–50% of younger people experiencing a relapse at some stage compared with the large majority of older people.

The authors refer to other research that includes statistics showing that most relapses happen during the first 18 months following successful treatment and that it is rare for people who have been in remission for 5 years or more to experience a relapse.

Symptoms of AML relapse

The symptoms of an AML relapse are similar to those that people may experience at the time of their initial diagnosis. According to the LLS, these symptoms can include:

The organization notes that these symptoms may reflect low counts of red blood cells (anemia), white blood cells, or platelets.

The diagnostic process for relapsed AML is similar to that of the original diagnosis. The tests a person may undergo include:

  • blood tests, to check blood cell counts
  • bone marrow tests, to look for cancer cells
  • flow cytometry, to evaluate specific markers on cancer cells
  • molecular tests, to study genetic elements in leukemia cells

Learn more about how doctors diagnose AML here.

Genetic testing of the leukemia cells during a relapse is important, as the chromosomal mutations may differ from those at the original diagnosis. Researchers say they would expect these differences, as mutations are gained and lost as the disease progresses.

Diagnostic factors

As in the initial diagnosis, doctors will consider a variety of factors when diagnosing a relapse and evaluating the person’s outlook. These factors include:

  • the location of the chromosomal changes
  • the number of affected chromosomes
  • gene mutations
  • markers on the cancer cells
  • white blood cell count
  • a person’s age
  • previous treatments

The treatment options for relapsed AML often depend on various factors, including the length of remission, previous treatments, and the person’s overall health.

Following AML relapse, doctors may recommend:

  • A new course of chemotherapy: A person may undergo the original therapy again or receive different drugs. Doctors often recommend additional chemotherapy with new drugs if the relapse occurs within the first year of successful treatment.
  • Allogeneic stem cell transplant: In this procedure, a person with AML receives healthy blood stem cells from a donor. The new cells replace damaged cells and help generate healthy cell production. According to the National Organization for Rare Diseases, doctors typically only recommend stem cell transplants for people under the age of 60 years or older people who are physically fit enough to tolerate the procedure.
  • Clinical trials: As with all medications, researchers use clinical trials to test new AML drugs. Doctors can help people with relapsed AML learn more about the options for participating in a clinical trial for new AML treatments.
  • Targeted treatment: These drugs target specific cell processes to reduce or prevent the formation of cancer cells while avoiding damage to healthy cells.
  • Palliative care: In cases when further treatment is no longer effective or desired, a person may choose to a shift to supportive care. This specialized medical care focuses not on curing the disease but on providing comfort and symptom management.

A doctor will discuss the best course of action for a person with relapsed AML in the context of their medical history and personal preferences.

Researchers often evaluate the outlooks for people with different cancers by studying the 5-year relative survival rate. This statistic compares the survival of people with a certain condition with that of people without the condition over 5 years.

According to the LLS, from 2010 to 2016, the 5-year relative survival rate for adults with AML was 29.8%. People under the age of 15 years had a 5-year relative survival rate of 70.6%. However, research in the journal Current Treatment Options in Oncology notes that outcomes vary depending on how long a person was in remission before relapsing and whether doctors recommend a stem cell transplant.

It is also important to remember that these statistics are estimates and do not reflect a person’s individual outlook. Advances in treatment methods may have improved survival rates in the years since the collection of these data.

The recurrence of any cancer, including AML relapse, can present emotional challenges. One 2019 study involving 208 people with AML found a link between the symptoms of anxiety and depression and unfavorable outcomes.

The American Cancer Society offers these tips for coping with the emotions of an AML relapse:

  • finding a support group online or in-person, such as through community centers or places of worship
  • talking with a doctor about concerns or seeking a second opinion on exploring new treatment options
  • getting professional counseling from a licensed psychologist or another therapist
  • being honest with friends and family about all feelings and emotions
  • talking with a doctor about treatment for symptoms of depression and anxiety

AML is a fast growing cancer that affects the blood and bone marrow. It can be difficult to treat, and many people experience a relapse, particularly in the first 18 months after treatment. The treatment options depend on many factors, including the subtype of AML, previous treatments, and the person’s age and overall health.

It is important to remember that each AML case is unique. A person’s healthcare team will work with them on the treatment plan that is right for them.