A relapse or recurrence after treatment occurs when laboratory values and physical signs and symptoms begin to trend in a deteriorating direction. These signs and symptoms may be quite similar to those that led to initial treatment. At this point, patients and their hematologist-oncologists are confronted with choosing the next appropriate course of action, be it continued periodic monitoring or re-treatment, which is sometimes referred to as salvage therapy.
The severity of symptoms, overall health condition, and quality of life will factor into the decision of when to begin re-treatment. The question becomes: Which treatment to choose? In general, if a patient has had good results with a prior therapy that led to a significant period of response (2 years or more), then a repeat treatment with the same therapy may be appropriate. If a prior therapy was not very effective or the response period was short, a different type of therapy may be indicated.
Fortunately, the choices of treatments for relapsed patients are many and are continually increasing. Patients also might want to consider participating in a clinical trial. It is perfectly appropriate when weighing treatment options following relapse to consult with a WM expert for a second opinion.