The diagnosis of relapse following therapy for acute myeloid leukemia (AML) can be made based on a number of findings. It is important to distinguish relapse from other conditions such as bone marrow regeneration.
Patient selection: history complete remission of AML
Relapse - one or both of the following in a patient who has had a complete response to therapy:
(1) bone marrow blast count >= 5% not attributable to regeneration or other cause
(2) reappearance of blasts in the peripheral blood with > 25% blasts in the bone marrow
(3) development of an extramedullary leukemia infiltrate
(4) reappearance of Auer rods
If the bone marrow blast count is 5 to 25% with or without blasts in the peripheral blood, then the bone marrow examination is repeated in >= 1 week(s). The presence of >= 5% blasts in the second sample indicates relapse (and not bone marrow regeneration).
Impending relapse may be heralded by development of myelodysplastic change affecting erythroid, myeloid or megakaryocytic lineages.
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