What is the 5-year survival rate for a patient with Acute Myeloid Leukemia (AML) who underwent chemotherapy initially and then required a bone marrow transplant due to recurrence?

5-Year Survival Rate for AML with Chemotherapy Followed by Bone Marrow Transplant for Relapse

For patients with AML who initially underwent chemotherapy, achieved remission, then relapsed and required allogeneic bone marrow transplant, the 5-year overall survival rate is approximately 25%, though this varies significantly based on disease burden at the time of transplant and duration of first remission.

Survival Outcomes Based on Disease Status at Transplant

The most critical determinant of survival after transplant for relapsed AML is the disease burden at the time of the second transplant 1:

• Low disease burden (absence of peripheral blood blasts and ≤5% bone marrow blasts): 5-year survival of 25% 1
• High disease burden (>5% bone marrow blasts or peripheral blood involvement): 5-year survival of 12% 1
• Overall median survival after second transplant for relapsed disease: 6 months 1

Prognostic Factors That Modify Survival

Several factors significantly impact outcomes in this clinical scenario 2, 1, 3:

Disease-Related Factors

• Duration of first remission is the most powerful predictor - patients with first remission <6 months have the worst prognosis 2
• Cytogenetics at original diagnosis remain prognostically relevant - favorable cytogenetics (CBF-AML, APL) have better outcomes than adverse cytogenetics 2
• Bone marrow blast percentage at time of transplant - each percentage point increase worsens prognosis 1, 3

Patient-Related Factors

• Age at relapse - younger patients (<40 years) have better outcomes than older patients 2, 3
• Performance status at time of transplant significantly affects treatment-related mortality 3
• Number of prior treatment regimens - more prior therapies correlate with worse outcomes 3

Context: Primary Refractory vs. Relapsed Disease

It's important to distinguish your scenario from primary refractory AML 3:

• Primary refractory AML (never achieved remission): 5-year event-free survival of only 10-20% with allogeneic transplant 3
• Relapsed AML (achieved CR, then relapsed): Better outcomes than primary refractory, particularly if first remission was prolonged 2, 1

Treatment-Related Mortality Considerations

The high-risk nature of transplant for relapsed disease must be acknowledged 1, 3:

• Treatment-related mortality is substantial, particularly in patients with high disease burden 3
• Relapse remains the primary cause of failure even after second transplant 1
• Only patients with favorable prognostic factors and available matched donors should be considered optimal candidates 3

Comparison to Standard First-Line Transplant Outcomes

For context, patients who undergo allogeneic transplant in first complete remission have significantly better outcomes 4:

• First CR transplant: 5-year overall survival of 35-62% depending on risk stratification 4
• Relapsed disease requiring second transplant: 5-year survival drops to 12-25% 1

This represents a substantial decrease in survival probability when transplant is performed for relapsed rather than first-remission disease 1.