Refractory or recurrent AML
Less than 15% of children have refractory AML (leukemia that does not respond to initial
treatment). These leukemias are often very hard to cure, and doctors may recommend a
stem cell transplant if it can be done.
Generally, the outlook for a child whose AML relapses (comes back) after treatment is
slightly better than if the AML never went into remission, but this depends on how long
the initial remission was. In more than half of cases of relapse, the leukemia can be put
into a second remission with more chemotherapy. The chance of getting a second
remission is better if the first remission lasted for at least a year, but long-term second
remissions are rare without a stem cell transplant. Many different combinations of
standard chemo drugs have been used in these situations, but the results have been mixed.
Most children whose leukemia has relapsed are good candidates for clinical trials testing
new treatment regimens. The hope is that some sort of a remission can be attained so that
a stem cell transplant can be considered. Some doctors may advise a stem cell transplant
even if there is no remission. This can sometimes be successful