Acute myeloid leukemia, also known as AML, is a cancer that originates in the bone marrow. The initial treatment for AML focuses on sending the cancer into remission. Sometimes after a period of remission the cancer will come back, leading to an AML relapse. AML relapses often have to be treated differently than the initial cancer.
Stem Cell Transplant
One of the most effective treatments for relapsed acute myeloid leukemia is a stem cell transplant, the American Cancer Society explains. The purpose behind performing a stem cell transplant is to replace the cancer cells in the bone marrow with healthy cells. This treatment begins with high doses of chemotherapy which destroy all of the cells in the bone marrow. Patients then receive a bone marrow stem cell transplant, which can be either from a donor or from the patient's cord blood if it was stored after birth. The donor cells are infused into the patient's blood stream and then naturally migrate to the bones, where they will repopulate the depleted bone marrow. This procedure may not be suitable for all patients. Because the treatment is very intensive, patients in poor health are not considered to be good candidates for this kind of treatment. It may also be difficult to find a suitable donor for bone marrow stem cells.
Intensive Chemotherapy
Patients who are unable to receive a stem cell transplant either due to poor health or a lack of a suitable donor may receive intensive chemotherapy in an attempt to send the leukemia back into remission. Different regimens can be used, Meds.com explains. Cytarabine, which is a very powerful chemotherapeutic compound, can be combined with either AMSA, etoposide or mitoxantrone. Intensive chemotherapy can induce remission for some patients, particularly those who had previously been in remission for a longer period of time.
Gemtuzumab
Gemtuzumab is a medication which is designed to deliver chemotherapy drugs specifically to cancerous cells. It uses special proteins, called antibodies, that are able to bind to AML cells; chemotherapeutic compounds are attached to the antibodies. A 2001 article in the Journal of Clinical Oncology found that gemtuzumab was effective at treating patients who had developed relapsed AML.
Arsenic Trioxide
Arsenic trioxide can be used for patients with a specific subtype of AML, called acute promyelocytic leukemia, who experience a relapse. This specific subtype of AML, the American Cancer Society explains, is typically initially treated with a compound called all-trans retinoic acid. Arsenic trioxide can be used if the all-trans retinoic acid treatment is ineffective or if the patient experiences a relapse. Patients that go into remission with arsenic trioxide may benefit from a stem cell transplant.
Palliative Care
Not all cases of relapsed AML will respond to chemotherapy or other treatments. In these cases palliative care may be recommended. Patients receiving palliative care may receive radiation treatment and pan-relieving medications to ease any discomfort. Patients may also receive blood transfusions to help with fatigue and a weakened immune system. Anti-emetics may also be given to patients suffering from nausea.
