Management of relapse

• Relapse rate is highest within the first 2 years but may occur after 7 years.

• 20% occur outside the bone marrow, generally CNS; testis and other sites occur in 5%.

• Isolated extramedullary relapse is often followed by haematological relapse; these patients require local treatment followed by reinduction therapy.

• Best predictive factor for response is duration of first CR (better >18 months).

• With second-line regimens 50-60% of patients will achieve a short second CR (generally <6 months) and prompt BMT offers the only prospect of LFS and cure.

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