Characteristics and outcomes of acute myelogenous leukemia patients with very late relapse (>5 years)

Abstract

The clinical characteristics and outcome of 15 patients with acute myelogenous leukemia (AML) who experienced relapse at least 5 years after induction of complete remission (very late-relapse AML) are described. This subgroup represented 3% of all relapsed patients seen at this institution over the same time period. There were eight males in this cohort and the median age at diagnosis was 48 years (range 13 - 77 years). Nine patients had M4/M5 French - American - British (FAB) classification subtype and most had intermediate risk cytogenetics. The median duration of first complete remission (CR-1) was 9 years (range 5.2 - 11.5 years). Thirteen patients (86%) achieved CR-2 with reinduction therapy. The 5-year relapse-free survival and overall survival rates of this cohort were 59% and 51%, respectively. We conclude that very late-relapse AML is a rare event, and that reinduction in these patients is associated with very high CR rates and a potential cure fraction.

Late relapse of acute myeloid leukemia with mutated NPM1 after eight years: evidence of NPM1 mutation stability

“…12 In weighing up the pros and cons, one realizes that the outcome of clinical decisions in patients such as this may help improve our understanding of the biology and clinical behavior of AML with mutated NPM1. Giovanna Meloni, 1 …”

Revisiting late relapses in acute myeloid leukemia

“…The current report, although quite different from another publication on this topic by Medeiros et al [2] earlier in this journal, helps to define the clinical landscape of patients with this rare entity. Both series define late relapse as AML recurring at least 5 years after attainment of first remission.…”

“…An earlier series by Kantarjian et al [3] used 18 months as the definition of late relapse. Together, these series indicate the risk of AML relapse after 18 months as 17% and after 5 years as between 1.16 and 3% [2,3]. Several important differences, however, exist between the MDACC and Princess Margaret Hospital (PMH), Toronto, series.…”

Management of AML: Who do we really cure?

“…Some relapses occur long after the original treatment and at a time that the patient might have been considered cured. Medeiros et al [35] reviewed 15 cases of relapse 5 or more years after CR. All cases had intermediate risk cytogenetics.…”