Survival Rate for AML After Third Recurrence

Prognostic Context for Multiple Relapses

The American Society of Hematology recommends that patients with AML experiencing a first relapse have a 5-year survival rate of 46% for the most favorable risk group and 4% for the unfavorable group 1
The European Society for Medical Oncology states that patients relapsing after allogeneic HSCT have 3-year survival probabilities of 4%, 12%, 26%, and 38% for those relapsing within 6 months, 6-24 months, 2-3 years, or >3 years after transplant, respectively 2, 3

By the third recurrence, patients have typically exhausted standard salvage chemotherapy options, undergone allogeneic HSCT, developed resistant disease biology, and accumulated treatment-related organ damage and comorbidities 1, 2

The National Comprehensive Cancer Network suggests that clinical trial enrollment should be the first priority for patients with AML experiencing a third recurrence, if available 2, 3, 4
For patients with FLT3-mutated AML, gilteritinib monotherapy may provide a median OS of 9.3 months in first relapse, but expect significantly less in third recurrence 2, 3
For patients not candidates for active therapy, the American Society of Clinical Oncology recommends best supportive care, focusing on transfusion support, cytoreductive therapy, palliative care consultation, and quality of life optimization 1, 2, 4

The 30-day mortality with intensive salvage chemotherapy in heavily pretreated patients can reach 14% or higher, making aggressive treatment questionable in third recurrence without extraordinary circumstances 1
Second allogeneic HSCT or donor lymphocyte infusion is only considered for patients relapsing >5 months after first transplant 2, 3

Donor Lymphocyte Infusion (DLI) combined with chemotherapy or FLT3 inhibitors is rarely effective in the long term for patients with AML recurrence after stem cell transplant, with low disease burden and longer time since first transplant 5, 6, 7
Sorafenib may achieve long-lasting responses in a small proportion of patients with FLT3-mutated AML 5, 6, 7

For FLT3-mutated AML, gilteritinib monotherapy provides median OS of 9.3 months in first relapse, but expect significantly diminished benefit in third recurrence, according to Haematologica 8
Sorafenib may achieve long-lasting responses in only a small proportion of patients with FLT3-mutated AML relapsing after transplant, as reported in Haematologica 8
Donor lymphocyte infusion combined with chemotherapy or FLT3 inhibitors is rarely effective in the long term for post-transplant relapse, as noted in Haematologica 8