Leukemia's second remission? Don't count on it, expert says

February 19, 2013 | by Tami Dennis

The sad fact is, despite doctors’ best efforts and chemotherapy’s best drugs, many people with acute lymphoblastic leukemia and acute myelogenous leukemia suffer a relapse after an initial remission. Then, they undergo a second round of best efforts and best drugs to achieve remission once more. Only then do they proceed to a bone marrow or stem cell transplant from a donor – a course of action which is the only chance for a cure. By that point, however, their odds are poor.

In the treatment of leukemia, doctors often wait for the second remission before transplant. There may be a better way, says City of Hope's Dr. Stephen J. Forman. In the treatment of leukemia, doctors often wait for the second remission before transplant. There may be a better way, says City of Hope's Stephen J. Forman.

Perhaps, suggests City of Hope’s Stephen J. Forman, M.D. , there’s a better way.

In an article published in the Feb. 14 issue of the journal Blood, Forman and co-author Jacob M. Rowe, M.D., recommend a series of actions that could improve the odds for patients with these diseases. Such actions, they say, could turn the likelihood of a cure from “myth” into “reality.”

Forman is chair of the Department of Hematology & Hematopoietic Cell Transplantation, as well as the Francis and Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation. Rowe is director of the Department of Hematology at  Shaare Zedek in Jerusalem.

In the article, “The myth of the second remission of acute leukemia in the adult,” the authors make their case by pointing out that most patients don’t achieve a second remission,  and thus don’t get the chance for a cure.

They suggest, among other things, the use of new  drugs that can  help a patient who has relapsed make it to transplantation, as well as new transplant  regimens that can reduce the risk of relapse after transplantation. Sometimes proceeding straight to transplant without additional therapy may be a good strategy for some patients, they also add, especially  if the first remission was short.

But they also recommend a very proactive course to ensure that patients can actually receive a transplant after they relapse.

“The first, and simplest, is to identify a donor early on in the course of treatment of the disease. We believe that family typing should be done in all patients with acute leukemia, not so much to plan transplantation for everyone, but to know what the options are,” they write. “After that, if necessary, plans can be made in an expeditious way, including performing searches through the National Marrow Donor Program and cord blood registries to know what the possibilities might be for the patient.”

The suggested measures are not meant to imply that all patients should undergo transplantation during their first remission, Forman and Rowe stress. The transplantation process is not easy, after all.

Rather, their arguments are meant to encourage a realistic assessment of a patient’s chances of achieving a cure, not blind adherence to a strategy based on “myth.”

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