Acute leukemia relapse occurs if the disease returns after treatment or becomes more aggressive during treatment. Both acute myelogenous leukemia (AML) and acute lymphocytic leukemia (ALL) can relapse.
Treatment for a relapse of leukemia depends on a variety of factors including:
During a relapse of leukemia, cancerous leukemia cells reappear in the bone marrow or other areas of the body. Acute leukemia relapse symptoms are the same as the initial symptoms of the disease. Common acute leukemia relapse symptoms include:
In cases of ALL relapse, leukemia cells may reappear in the bone marrow, the central nervous system, the brain, the spine or, for males, in the testes. Of the three locations, ALL relapse in the bone marrow is the most serious.
Treatment depends on the location of the ALL relapse cells. Leukemia relapse in the central nervous system may be treated with chemotherapy drugs delivered through spinal taps. ALL relapse affecting the testicles may be treated with focal radiation and chemotherapy.
Bone marrow involvement in ALL relapse can be treated with chemotherapy, but when remission is achieved it is rarely long term. Bone marrow or stem cell transplants offer a better chance of long-term remission after an ALL relapse, although a subsequent leukemia relapse after bone marrow transplant is always a possibility. Experimental drugs may also be used to treat a leukemia relapse.
ALL relapse has a relatively positive prognosis when compared with other types of leukemia relapse. According to A.D.A.M. (2007), 50 to 70 percent of children who experience ALL relapse achieve a complete second remission. Adults have slightly lower rates of relapse remission, with 40 to 50 percent experiencing a second remission.
AML leukemia relapse cases are usually treated with either chemotherapy or stem cell transplantation. Patients who are unfit for bone marrow transplantation, however, generally respond poorly to chemotherapy treatment for AML leukemia relapse. Some patients have responded well to treatment with the monoclonal antibody gemtuzumab ozogamicin, but further study is required to determine the length of remission resulting from this treatment.
Leukemia and Lymphoma Research reports that AML relapse rates vary from 30 to 80 percent, depending on the age of the patient. Risk groups for AML leukemia relapse cases are classified by chromosomal changes in the leukemic cells. Patients in low-risk groups may initially be treated with intensive chemotherapy, while those in high-risk groups are more likely to be treated with stem cell transplants.
A.D.A.M. (2009). Acute lymphocytic leukemia (ALL). Retrieved April 23, 2010, from http://health.nytimes.com/health/guides/disease/acute-lymphocytic-leukemia-all/treatment-after-relapse.html.
Health Communities. (n.d.). Leukemia signs and symptoms. Retrieved April 23, 2010, from http://www.oncologychannel.com/leukemias/symptoms.shtml.
Leukemia and Lymphoma Research. (n.d.). Adult acute myeloid leukaemia. Retrieved April 23, 2010, from http://www.llresearch.org.uk/en/1/infdispataml.html.
Merck Manuals Online Medical Library. (2008). Acute leukemia. Retrieved April 23, 2010, from http://www.merck.com/mmpe/sec11/ch142/ch142b.html.
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