Mortality and relapse dynamics in AML after three years of complete remission

Patients with AML remain at risk of death after therapy. Our objective was to characterize patients with AML after three years in remission. 453 patients were documented to be alive and in remission 3 years after diagnosis, median follow-up was 7.2 years in this subgroup. 363 (80%) patients were alive at last follow-up, fifty-two (11%) relapsed, 40 died from relapse. Forty-seven (9%) died in remission. Among remission deaths, mutations in FLT3 (64% v 5%) and NPM1 (45% vs 20%) were common (p < 0.01); causes of death included: other cancers (26%), cardiovascular disease (6%), and graft-versus-host disease (6%). After 3 years in remission, the cumulative incidence of relapse was 8% (95%CI 5-11) and death was 11% (95%CI 8-14). Survival after 3 years in remission was similar to a matched general population cohort (p = 0.7). After 3 years in remission, most common causes of death were relapse, other cancer, or cardiovascular disease.