Late relapses in acute myeloid leukemia: analysis of characteristics and outcome

Abstract

Relapse after 5 years of complete remission (CR) is uncommon in acute myeloid leukemia (AML). Among 2347 patients seen between 1980 and 2008, 1366 achieved CR; 942 relapsed. Eleven (1.16% of all relapses) relapsed after a CR of >5 years. The median age was 66 years (range, 37–79). Initial therapy was cytarabine plus anthracycline in six, amsacrine-based in three, and other in two. The median CR1 duration was 81 months (range, 60–137). At relapse, the karyotype was different from the initial finding in five of eight (63%) patients with available data. Treatment for relapse included cytarabine with anthracycline in eight, and other in three patients, with a second CR (CR2) achieved in four (36%). The median CR2 duration was 1 month (range, 0–37), and median survival after relapse was 6.4 months (range, 1–39). Late relapses in AML are infrequent, with poor response to therapy. Karyotype at relapse is frequently different, raising the question of second AML versus relapse with the original clone.

Younger adults with acute myeloid leukemia in remission for ≥3 years have a high likelihood of cure: The ECOG experience in over 1200 patients

“…For example, median OS after late relapse was 6.4 months in 1 study [4], compared to significantly longer survival times reported by us and Medeiros and colleagues. [3] This may be related to differing rates of t-AML versus true late relapse.…”

“…[2] More recent studies defining late relapse as recurrence after 5 years have reported much lower rates of late relapse (0.8% of CR1 patients in 1 study). [3,4] Our study is unique in that we define late relapse as occurring after 3 years of CR1 and report the number of late relapses in terms of all patients in follow-up and still in CR1 at 3 years—14 of 426 (3.3%). Reporting late relapses solely in terms of all patients achieving CR1—1.1% of patients in our study—may not reflect the true rate of late relapse since many patients relapse early, die of other causes, or are lost to follow-up before 3 years.…”

“…In the study by Verma and coworkers, 5 of 8 patients tested had new cytogenetic abnormalities at late relapse (>5 years of CR1), including 3 patients with complex cytogenetics, del(5q), and monosomy 7. [4] A study using CR1 duration of 18 months to define late relapse found new cytogenetic abnormalities in only 3 of 15 patients. [5]…”

“…While previous reports have considered patients in remission for 3 or more years to be “potentially cured” [7,8], past studies have used various CR1 durations to define late relapse, most commonly 18 months [2,5] or 5 years [3,4], making it difficult to compare studies, assess the overall risk of late relapse, and determine potential risk factors and outcomes in late relapse patients. We have examined the long-term follow-up data of a large cohort of newly diagnosed AML patients treated on Eastern Cooperative Oncology Group (ECOG) protocols over the last 25 years, focusing on the incidence of late relapse and the characteristics and outcomes of these patients.…”

Isolated Recurrence of Intracranial and Temporal Bone Myeloid Sarcoma -Case Report-

“…Relapse after 5 years of CR is infrequent, occurring in about 0.8% of all patients who achieved CR or 1.2% of all relapsed patients. 16) Since few patients relapse after achieving CR for more than 5 years, such patients can be considered potentially cured. However, the possibility of MS recurrence must be considered in leukemic patients.…”