Relapsed or Resistant Leukemia

This content has been reviewed and approved by

Hagop M. Kantarjian, MD
Chairman & Professor, Leukemia Department
MD Anderson Cancer Center
University of Texas

High-dose chemotherapy and autologous stem cell transplant is a treatment option if remission induction therapy fails. This is because the bone marrow contains many leukemia cells, and your leukemia is considered "resistant" to treatment. If your remission induction therapy fails, your treatment choices are allogeneic stem cell transplant, Mylotarg® (gemtuzumab ozogamicin), or chemotherapy (alone or in combination).

If your acute myeloid leukemia (AML) relapses after an initial complete remission ("relapse"), you may be cured with autologous stem cell transplant. Many centers have reported cure rates of 25 percent for patients with AML transplanted in second remission or early in first relapse.

These results are often obtained because patients had their stem cells collected and stored at the time of their initial remission. Collecting stem cells after relapse is less successful because less than half of patients receiving induction chemotherapy again will achieve a second remission. Patients without previously stored stem cells, therefore, are often treated with allogeneic stem cell transplant or additional chemotherapy.

For these patients, allogeneic stem cell transplantation offers the only prospect of long-term, disease-free survival. If a compatible family member donor or autologous stem cells are not available, there should be a search for an unrelated donor or an umbilical cord source of stem cells.

Patients who are unable or unwilling to receive a stem cell transplant now have a new treatment option. This treatment does not produce the toxic side effects associated with high-dose therapy and transplantation. Gemtuzumab ozogamicin is the first antibody-targeted chemotherapy. It is approved by the FDA for the treatment of elderly patients with recurrent AML. Clinical trials are in progress to evaluate its efficacy alone and in combination with other therapies in different stages of AML.

Because Mylotarg mainly targets cancer cells, healthy cells are not destroyed. This is unlike chemotherapy or radiation. These two treatments attack cancer cells and healthy cells. Both cause considerable side effects.

Research is in progress to refine existing treatments and develop new ones. For information on some of the techniques currently under investigation, see Strategies to Improve Treatment.