These two types of AML are different. While relapsed AML refers to leukemia that has returned after receiving treatment and reaching remission, refractory AML means it did not respond to treatment.

People with AML can typically achieve the absence of signs and symptoms, called remission, after undergoing treatment. However, this is not the case for everyone.

If someone does not reach remission after two chemotherapy cycles, doctors consider them to have refractory AML. This means they may need to undergo different types of treatment.

This article will review relapsed and refractory AML, its signs, symptoms, and causes, and how doctors treat it.

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Relapsed AML and refractory AML are different.

After two cycles of chemotherapy treatment, if a person with AML still experiences signs or symptoms of AML and does not achieve remission, doctors typically diagnose refractory AML. This means it is not responding to chemotherapy and a person may have to receive other types of treatment.

After undergoing treatment for AML and achieving remission, someone with AML may also experience a return of leukemia cells in their bone marrow and a reduction of blood cells. Doctors call this event relapsed AML.

When AML comes back, leukemia cells may be different from the previous cancerous cells. Therefore, a person may need a different form of treatment.

Relapsed AML typically happens within 2 years after the first round of chemotherapy treatment. While relapses may occur at a later stage, they are less common.

The signs and symptoms a person with AML may experience can vary depending on the type of blood cells that the body is underproducing. These may include:

  • discoloration of the skin due to anemia
  • fatigue
  • breathlessness
  • bruising
  • unusual and frequent bleeding
  • frequent infections
  • bone and joint pain
  • fever and night sweats
  • red, purple, or discolored spots on the skin
  • unexplained weight loss
  • abdominal discomfort
  • swollen glands

Health experts do not know the specific genetic mutation that causes AML.

A person with AML tends to produce more white blood cells than necessary. These cells are not fully developed and cannot fight infections. The increased production of white blood cells also leads to a decrease in red blood cells and platelets, which is often the cause of AML symptoms.

Certain factors may also increase the risk of developing AML, including:

  • smoking
  • exposure to the chemical benzene
  • exposure to radiation
  • having undergone chemotherapy or radiotherapy
  • having a blood disorder
  • having certain genetic disorders, such as Down’s syndrome or Fanconi’s anemia

The treatment for relapsed and refractory AML may vary from person to person depending on various factors, including:

  • age
  • health conditions
  • the type of treatment received in the past
  • the length of the remission period

The treatment that doctors recommend to people with AML may include:

  • Chemotherapy and radiation therapy: These can help induce AML remission by destroying leukemia cells.
  • Stem cell transplant: People who achieve AML remission may receive a transplant of healthy stem cells from a donor. These may help maintain remission and reduce the risk of relapses.
  • Donor lymphocyte infusion: This consists of an infusion of blood from the donor of stem cells and bone marrow. This blood is rich in white blood cells, which can help boost the immune system of the recipient with AML and may help it fight the condition.
  • Targeted therapy: This may help target a specific gene mutation that may be causing AML.

The 5-year overall survival rate for people with AML is 31.7%. However, this may vary depending on the age of the person with AML.

About 67% of people with AML reach remission after the first round of treatment.

Children also tend to have better outlooks than older individuals. While about 90% of children with AML achieve remission, only about half of those over 60 years of age do.

The following table shows the 5-year survival rates for different age groups.

Age5-year survival rate
14 or youngeraround 70%
15–34around 52%
35–54around 37%
55–64around 20%
65 or olderaround 9%

If a person experiences any symptoms of leukemia, it is a suitable idea to contact a doctor.

AML symptoms are similar to those of other conditions. A doctor can diagnose whether a person may have AML or if they may have another underlying condition. If someone had AML in the past and they have any concerns about it coming back, they can contact a doctor and discuss the next steps.

Most people with AML can achieve remission after undergoing the first round of chemotherapy. However, this treatment may sometimes not be enough to induce remission.

People who achieved AML remission may also experience a comeback of leukemia, sometimes after years of remission. Doctors call this relapse.

Relapsed AML is more common within 2 years after starting AML treatment but may also happen later.