AML Survival After 3 Years in Remission Comparable With General Population

Patients with acute myeloid leukemia in remission for over 3 years experience survival rates comparable with a matched cohort from the general population.

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Patients with acute myeloid leukemia (AML) who remain in complete remission (CR) for at least 3 years have a similar overall survival (OS) to the general population, according to research published in Leukemia & Lymphoma.1

As more treatments and combinations have been developed to treat AML, survival rates have improved decade by decade, with composite complete remission rates improving to more than 90% when using venetoclax as part of a frontline intensive regimen.

“Survival trends for AML since the 1980s have shown consistent improvements, especially for patients aged less than 60 at diagnosis,” the authors wrote. “As a result, the number of AML survivors is thus expected to continue increasing. Despite these improvements, the specific long-term needs of AML survivors and the complications they are at increased risk for developing remain poorly understood.”

This single-center retrospective analysis included 435 patients diagnosed with AML between 1991 and 2015 at the University of Texas MD Anderson Cancer Center who had been in complete remission for at least 36 months. The median follow-up was 7.2 years (range, 3-24). The median age at diagnosis was 51 years, and at relapse it was 62 years.

Only 11% of patients relapsed after 3 years in remission, and 9% died from AML relapse. A similar proportion—10%—died from nonrelapse causes. The characteristics of the patients who died because of a relapse and the patients who died during relapse were similar:

• The median age for both groups was 59 years
• Diploid cytogenetics was seen in 48% of the relapse death group and 40% in the nonrelapse death group
• Complex karyotype was present in 10% of the relapse death group and 9% of the nonrelapse death group
• The most common mutation was FLT3-ITD (60% in the relapse death group and 64% in the nonrelapse death group), followed by RAS (55% vs 51%)
• The investigators did find that mutations in FLT3, NPM1, IDH1, IDH2, and DNMT3A were more common in patients who died in remission compared with patients who relapsed

For 43% of the patients who died of nonrelapse causes, the researchers were not able to determine the cause of death. However, 12 patients died from other malignancies, 3 died of cardiovascular disease, 3 from graft-vs-host disease, 2 from infection, 3 from kidney or liver failure, and 1 from Alzheimer disease. There were also 2 leukemia-related deaths among patients receiving maintenance therapy.

Other research into the nonrelapse mortality of patients on chimeric antigen receptor T-cell therapies and bispecific antibodies has identified that infections were the leading causes for both treatments.2,3 The findings highlight the importance of infection reporting, prevention, and mitigation.

At 5 years, the cumulative incidence of relapse (CIR) was 8%, and the cumulative incidence of death (CID) was 11%. At 12 years, the CIR was 17% and the CID was 27%. Putting these rates in perspective, the researchers used US populational data and matched for age, race, gender, and calendar year. “The matched relative survival of patients in remission after 3 years was similar to the population-matched survival,” they noted.

The lack of data on the cause of death for 43% of the patients who died while in remission was a major limitation of the study since they could have died due to comorbidities related to treatment or late relapses or completely unrelated causes. The authors suggested future research identify comorbidities and their impact on quality of life for these patients who survive AML.

“Effective surveillance strategies are essential to enable the early detection of relapse and facilitate timely interventions,” the authors concluded. “Patients with favorable-risk disease, who are less likely to die from relapse, may serve as a focus for initial survivorship strategies focused on secondary cancer screening and cardiovascular risk reduction.

References

1. Urrutia S, Jen W-Y, Sasaki K, et al. Mortality and relapse dynamics in AML after three years of complete remission. Leuk Lymphoma. Published online August 19, 2025. doi:10.1080/10428194.2025.2547984

2. Cordas Dos Santos DM, Tix T, Shouval R, et al. A systematic review and meta-analysis of nonrelapse mortality after CAR T cell therapy. Nat Med. 2024;30(9):2667-2678. doi:10.1038/s41591-024-03084-6

3. Tix T, Alhomoud M, Shouval R, et al. Non-relapse mortality with bispecific antibodies: A systematic review and meta-analysis in lymphoma and multiple myeloma. Mol Ther. 2025;33(7):3163-3176. doi:10.1016/j.ymthe.2025.03.048