Minimal residual disease (MRD) is the name given to small numbers of leukemia cells that remain during treatment or after treatment when the patient has no symptoms or signs of disease and appears to be in remission. MRD is the most accurate predictor of relapse, so the goal is to achieve complete molecular remission.
n WHAT IS REFRACTORY AML? Refractory AML occurs when the disease fails to go into remission after completion of induction chemotherapy. Children with refractory AML require a more aggressive treatment to achieve remission.
n WHAT IS RELAPSE? Relapse occurs when the AML cells return in the bone marrow after remission has been achieved. If your child’s AML relapses, your healthcare team will meet with you to discuss further treatment options.
n WHAT FACTORS AFFECT PROGNOSIS AND TREATMENT? About 67% of children and adolescents younger than 19 years who are diagnosed with AML are cured, which means they do not have any signs of cancer for 5 years after completing therapy. Cure rates for children with refractory or relapsed AML are much lower. How well a child recovers from AML depends on several factors: • the child’s age at diagnosis • race or ethnicity • obesity • whether AML occurred after a previous cancer treatment • the type of AML • certain chromosome or gene changes in the leukemia cells • if the child has Down syndrome • if the leukemia is in the brain and spinal cord
• if the leukemia went into remission after the first cycle of chemotherapy • if AML has returned, the length of time from remission to relapsed disease.
n HOW LONG DO THERAPIES LAST? Treatment for AML generally lasts 6–8 months. If your child undergoes a bone marrow transplant, recovery time may be longer than if he or she were treated only with chemotherapy. Many children will experience treatment delays due to prolonged thrombocytopenia, neutropenia, or serious side effects of treatment. As a result, it often is difficult to predict exactly when treatment will end.
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