Treatment After Relapse

Between 50 - 70% of children and 40 - 50% of adults who achieved complete remission after initial therapy and who relapse will achieve a second complete remission.

Treatment for relapse after a first remission may be standard chemotherapy or investigative drugs, or more aggressive treatments such as stem cell transplants.

Text Continues Below

---

The decision depends on a number of factors:

• Children who relapse 3 or more years after achieving a first complete remission have an excellent chance for a second remission without aggressive treatments.
• Those who relapse less than 6 months following initial treatment, especially while on chemotherapy, have about a 20% chance of long-term freedom from disease. In such cases, remission is possible following another course of standard chemotherapy but the duration of remission is usually less than 6 months.

Treatment decisions also rely on prior treatments and where the relapse has occurred. Relapse can occur in the bone marrow, central nervous system, or sanctuary disease sites (brain, spine, or testicles). The incidence of relapse in sanctuary sites is about 10%.

Candidates for transplantation include the following:

• Patients who relapse following initial remission with standard chemotherapy.
• High-risk patients in first remission who are unlikely to be cured by standard chemotherapy alone. Many adult patients may fall into this category. Studies on high-risk children have been conflicting about the value of transplants during a first remission, with a 2000 study reporting no significant advantage. A 2001 study on children with the Philadelphia chromosome, however, suggested that this approach offered a better chance for a cure.
• Patients who fail to achieve a complete remission during initial chemotherapy.