Early Relapse

The development of new disease during induction, although uncommon with the regimens currently in wide use, portends early death since a durable major response to different chemotherapy or to non-chemotherapeutic measures is unusual. The chance for cure is only slightly better when relapse occurs in the 6- to 12-month period after stem-cell rescue. In this situation, management is similar to that of primary refractory disease (see above), except that there is no role for (repeat) myeloablative therapy and organ toxicity may limit chemotherapeutic options. Poor bone marrow reserve post-transplant can be an obstacle to aggressive retrieval therapy,but this problem has lessened considerably with the excellent hematologic recovery that follows use of abundant peripheral blood stem cells (for the initial stem-cell rescue) or with the availability of previously collected stem cells for use with the retrieval program.

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