A bone marrow or stem cell transplant may be beneficial for people with intermediate- to high-risk acute myeloid leukemia (AML) who are in remission and can tolerate an intensive treatment plan.

Acute myeloid leukemia (AML) is a fast-growing type of leukemia.

When you have AML, abnormal white blood cells in your bone marrow (called leukemia cells or blasts) grow and divide uncontrollably. When this happens, they crowd out your healthy red blood cells, white blood cells, and platelets.

One of the treatments that may be recommended for AML is a stem cell transplant (SCT).

Bone marrow vs. stem cell transplant

A bone marrow transplant is a type of SCT, the terms may be used interchangeably. The procedure might also be called a “peripheral SCT” if the stem cells come from a donor’s blood rather than their bone marrow.

Treatment for AML is generally divided into two phases:

  1. Induction: During induction, chemotherapy (chemo) is used to reduce the number of leukemia cells in your body and achieve remission. Remission typically means that your bone marrow has less than 5% of leukemia cells, your blood cell counts are within a normal range, and you have no signs or symptoms of AML.
  2. Consolidation: Once remission is reached, additional treatment is given to eliminate any leukemia cells that remain in your body to help maintain remission.

An SCT may be used as a part of consolidation treatment for some people with AML, particularly those with intermediate- and high-risk AML, who are in remission and can tolerate a more intensive treatment.

The goal of an SCT is to reestablish a healthy bone marrow that’s free of leukemia cells.

In an SCT, high doses of chemo kill the cells in your bone marrow. Then, an infusion of healthy stem cells is given. These can be collected from a donor’s bone marrow (a bone marrow transplant) or blood (a peripheral blood SCT).

The most common type of SCT for AML is an allogenic SCT. This uses stem cells collected from a healthy, matched donor. The donor is often a close relative, such as a sibling.

An SCT can be a potential cure for some people with AML. But the effectiveness of an SCT depends on several factors.

One of these is timing. According to information from the Leukemia and Lymphoma Society, having an SCT after your first remission offers you the best chance of preventing AML from returning.

Another factor is minimal residual disease (MRD). This is when a small number of leukemia cells remain in your body after treatment. A 2017 study found that MRD prior to an SCT was associated with a higher risk of AML coming back and worse survival.

The genetics of AML cells also play a role. The presence of certain genetic changes can increase your risk of AML coming back after an SCT.

Cure vs. remission in cancer

  • Cure. Generally speaking, a cure means that treatment has removed all traces of cancer, no more treatment is needed, and the cancer is not expected to return.
  • Remission. Remission is a period of time when the cancer has been reduced or has gone away entirely. Complete remission means there aren’t any detectable signs of cancer. Partial remission means there are far fewer cancer cells, but they may still be detectable.

AML can come back after an SCT. This is called a relapse. Relapses aren’t uncommon in AML. Researchers have estimated that about 30 to 40% of people who receive an SCT for AML will have a relapse.

Generally speaking, many relapses occur in the months following an SCT. For example, a 2020 study found that the incidence of an AML relapse peaked 3 to 6 months after an SCT.

Maintenance therapy to prevent relapse

After an SCT, you may be given treatment to help prevent a relapse. This is called maintenance therapy and may include:

Treatments following a relapse

If AML does relapse, other treatments may be offered. These may include:

  • chemo
  • targeted therapy
  • DLI
  • a second SCT

Relapsed AML can be challenging to treat. The outlook for people with it is poor. As such, it’s possible that your care team may suggest participation in a clinical trial. Clinical trials test the safety and effectiveness of newer treatment types.

According to the Surveillance, Epidemiology, and End Results Program database of the National Cancer Institute, the 5-year survival rate for people with AML is 30.5%. This is the percentage of people with AML that are alive 5 years after receiving a diagnosis of AML.

Receiving an SCT can help to improve survival in people with AML. For example, a 2016 study found that people treated with chemo followed by an SCT had a 5-year survival of 44.1% compared with 37.8% for those receiving chemo alone.

SCTs are very hard on your body. As such, they can be associated with complications and death. But 2020 research has found that transplant-related deaths have greatly decreased over the past 40 years.

It’s possible for those who’ve had an SCT to have health problems going forward, though. A 2022 study found that people who had received an allogeneic SCT for AML were more likely than their matched sibling donors to:

  • report poor general health
  • experience limitations in activity and functioning
  • develop potentially serious conditions such as second cancers or venous thromboembolism

Because SCTs are hard on your body, they’re not recommended for everyone. Additionally, some people may choose not to receive an SCT as a part of their AML treatment.

When an SCT isn’t done, consolidation treatment typically involves chemo. Targeted therapy drugs may also be used.

The outlook for people with AML is typically not as positive without an SCT. The American Cancer Society notes that allogenic SCTs as a part of consolidation treatment generally have an improved response rate compared with using chemo alone.

A 2018 study looked at 10-year outcomes of people who didn’t have an allogenic SCT during their first remission. It found that only 16.6% of people younger than 60 years old and 2.4% of people 60 years old and older were disease free 10 years after receiving a diagnosis of AML.

An SCT may be used as a part of consolidation treatment in people with intermediate- to high-risk AML that can tolerate an intensive treatment. In some situations, an SCT can be a cure.

Nevertheless, it’s still possible for AML to relapse after an SCT. There are several factors that can increase the risk of this. Often, maintenance therapy is used to help reduce your likelihood of an AML relapse.

While SCTs can improve the outlook for a person with AML, they’re not recommended for everyone. If you’ve recently received a diagnosis of AML, talk with a healthcare team about whether or not an SCT is recommended as a part of your treatment plan.