What Is a Relapse of Acute Myeloid Leukemia?

Medically Reviewed by Arefa Cassoobhoy, MD, MPH on September 19, 2023
3 min read

The goal of acute myeloid lymphoma (AML) treatment is to put you into remission -- when you have no leukemia cells  found in your blood or bone marrow and you have no symptoms of the disease. Most people who are treated go into remission, but it doesn't always last. A relapse means that your leukemia has come back.

Keep in mind that if your cancer returns, you still have treatment options.

Your doctor will tell you that you've relapsed if the number of leukemia cells in your bone marrow has gone up and you have fewer healthy cells in your blood.

AML can relapse if:

  • The cancer didn't respond well to the first treatment you tried
  • Treatment didn't get rid of all the leukemia cells
  • Cancer cells spread to other parts of your body and were too small for tests to pick up

AML can relapse months or years after your first treatment.

One way to find out is to look for symptoms, which might be the same ones you had when you were first diagnosed.

AML that has relapsed can cause symptoms like these:

  • Bruises
  • Swollen glands
  • Tiredness
  • Shortness of breath
  • Fever
  • Sweating
  • Headaches
  • Achy bones

Many other things can cause those symptoms, too. Your doctor will need to do tests to find out if you've had a relapse or if something else is going on. You might have some of the same tests as when you were first diagnosed:

Blood tests. These tests check the numbers of normal blood cells and leukemia cells in a sample of blood taken from your vein.

Bone marrow test. This test removes a sample from your bone marrow to check the number of leukemia cells and looks for gene changes in the cancer cells.

Lumbar puncture. For this test, your doctor removes a little bit of the fluid from around your spinal cord. Your medical team will check it for leukemia cells.

Chest X-ray. Doctors use these X-rays to look for enlarged lymph nodes in your chest.

Which treatment you get for a relapse depends on:

  • Your age
  • How long you were in remission
  • The kind of gene changes your doctor finds in your leukemia cells

If your AML doesn’t go away with the first treatment, your doctor may recommend newer drugs or more intensive doses of chemotherapy.

If AML has spread to your brain and spinal cord, you may get the chemo straight into your spinal fluid. A procedure called a lumbar puncture uses a needle to place the medicine into your lower back and spine.

Targeted drugs block proteins, blood vessels, and other things that help leukemia cells grow. Your doctor may suggest these drugs to treat relapsed AML or mutations:

  • Enasidenib (Idhifa)
  • Gemtuzumab ozogamicin (Mylotarg)
  • Ivosidenib (Tibsovo)
  • Gilteritinib (Xospata)

A bone marrow or stem cell transplant is another treatment for relapsed AML. First, you get high-dose chemotherapy to kill as many cancer cells as possible. Then you get healthy stem cells from a donor to replace the blood cells that chemo destroyed.

If your AML doesn't improve with treatment or it keeps coming back, you may want to ask your doctor about clinical trials. These are studies that test new drugs, combinations of chemotherapy, or other treatments to see if they're safe and if they work.

The treatment you get in a clinical trial may be better than currently available cancer drugs. Ask your doctor about any trials that might be a good fit for you. Be sure you know what’s involved and what the pros and cons are, just like with any other treatment.  

AML and its treatments can cause side effects like fatigue, pain, and nausea. Palliative care helps you feel better while you go through cancer treatment. In addition to your regular treatment, it can help with any pain you have and improve your quality of life. It’s not the same as hospice care, which is for the final stages of cancer or another serious illness.

You can get palliative care in a hospital, outpatient clinic, or at home.

Palliative care for AML might include:

  • Blood transfusions to ease tiredness
  • Growth factors to help rebuild your bone marrow after chemotherapy
  • Antibiotic or antiviral drugs to prevent infections
  • Radiation to ease bone pain
  • Medicines for nausea or pain

You might also consider therapy, counseling, or a support group to help manage the stress of living with AML.