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Very Late Relapse in Pediatric Acute Myeloid Leukemia: A Case Report and Brief Literature Review
Graham D Unis1, Nathan VanderVeen2, Matthew Fletcher1
1Ochsner Hospital for Children, New Orleans, LA.
Insights
Very late relapses in childhood acute myeloid leukemia (AML) are rare. This study details a unique case of AML relapse 12 years post-transplant, exploring potential mechanisms for these infrequent events.
Area of Science:
- Pediatric Hematology Oncology
- Cancer Genetics
- Stem Cell Transplantation
Background:
- Acute myeloid leukemia (AML) is a rare childhood cancer with high remission rates but significant relapse risk.
- Relapse typically occurs within 3 years, with very late relapses (>5 years) being uncommon (1-3%).
- Genetic translocations, such as AFDN/KMT2A, play a role in AML development and prognosis.
Observation:
- A case of pediatric AML with an AFDN/KMT2A translocation is presented.
- The patient experienced a very late relapse 12 years after a matched sibling stem cell transplant.
- This case highlights the possibility of long-term disease recurrence in specific AML subtypes.
Findings:
- The AFDN/KMT2A translocation is associated with AML in pediatric patients.
- Very late relapse after stem cell transplant can occur even in cases with favorable initial response.
- Mechanisms underlying very late relapse in AML require further investigation.
Implications:
- Understanding mechanisms of very late relapse is crucial for long-term surveillance strategies in pediatric AML survivors.
- This case underscores the importance of continued monitoring for recurrence in AML patients.
- Further research into genetic factors and immune reconstitution may elucidate pathways leading to late AML relapse.
Abstract:
Acute myeloid leukemia (AML) is a heterogenous group of diseases affecting ~500 children in the United States annually. With current therapy, 90% of these children will obtain complete remission. However, 30% to 40% of these patients will relapse, most commonly within the first 3 years. Very late relapses, defined as relapse occurring >5 years after complete remission, are rare, accounting for 1% to 3% of relapses. We describe a patient with AML harboring an AFDN/KMT2A translocation who relapsed 12 years after matched sibling stem cell transplant, provide a brief review of the relevant literature, and describe proposed mechanisms to explain very late relapse AML.
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