What regular blood work should be done routinely for patients with cured acute myeloid leukemia (AML)?

Routine Blood Work for Patients with Cured Acute Myeloid Leukemia

For patients with cured AML in complete remission, perform CBC with differential every 1-4 months during the first year, every 3-6 months during the second year, and every 6-12 months from the third year onward. 1

First Year Post-Treatment Surveillance

During the initial 12 months after completing therapy (including any maintenance):

• CBC with differential every 1-4 months 1
• Liver function tests until normalized 1
• Physical examination at each visit (including testicular exam if applicable) 1

The more frequent monitoring during this period captures the highest risk window for relapse, which occurs predominantly in the first two years after achieving remission.

Second Year Post-Treatment

• CBC with differential every 3-6 months 1
• Physical examination every 3-6 months 1

This interval reflects the declining but still significant relapse risk during the second year of remission.

Third Year and Beyond

• CBC with differential every 6-12 months or as clinically indicated 1
• Physical examination every 6-12 months 1

After two years in remission, the relapse risk decreases substantially, allowing for less intensive monitoring.

Special Considerations for Acute Promyelocytic Leukemia (APL)

For patients with APL specifically, the monitoring strategy differs:

• PCR testing on bone marrow at completion of consolidation to document molecular remission 1
• Subsequent PCR monitoring can use peripheral blood samples, though bone marrow is more sensitive for detecting early relapse 1
• For intermediate- or high-risk APL patients: periodic monitoring every 3 months for up to 2 years during maintenance therapy 1
• For low-risk APL patients in molecular remission after consolidation, the relapse risk is low and PCR monitoring may be more appropriate in clinical trial contexts 1

When to Escalate Testing

If new cytopenias develop with negative disease markers, perform bone marrow biopsy to assess for secondary myelodysplastic syndromes or secondary AML, which can rarely occur after AML treatment 1

If CBC worsens or remains abnormal over two or more measurements, proceed to bone marrow evaluation rather than continued CBC monitoring 2

For suspected relapse, perform bone marrow aspirate with flow cytometry, comprehensive cytogenetics, FISH, molecular tests, and MRD assessments 1

Additional Monitoring Based on Treatment Exposure

• Echocardiogram as clinically indicated to monitor for late cardiotoxicity from anthracycline exposure 1
• Neuropsychological testing as clinically indicated given increased neurotoxicity risk from AML treatment 1
• Monitor for healthy weight and encourage healthy lifestyle choices due to increased obesity risk in survivors 1

Critical Pitfalls to Avoid

Do not continue frequent monitoring indefinitely without adjusting intervals - lengthen monitoring intervals once stability is established to avoid unnecessary testing and patient burden 2

Do not rely solely on peripheral blood for molecular monitoring in APL - bone marrow samples provide more sensitive detection of early molecular relapse 1

If PCR converts from negative to positive in APL patients, confirm with bone marrow analysis within 2-4 weeks before initiating treatment for relapse, as false positives can occur 1