Step 9: Relapse: Do You Need a Change in
Treatment?
Criteria for relapse met
Key Information
·M-component relapse (or
Freelite)
·Rapid relapse ( 2 mos)
·CRAB features and/or other
clinical problems
Variables
·Age
·Other medical issues
·Risk factors
·Prior response
·Costs
·Preference

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Step 9: Selecting Relapse Therapy
Continue to monitor closely
Early Relapse
Step 10
(M-Comp only)
Additional testing: e.g. bone
marrow; PET/CT...
Rapid Relapse
CRAB/Clinical
If relapse
Issues
Options
·Same as prior
·Auto-transplant
Relapse
·Localized radiation
RX
·Supportive care
·Novel combination
·Chemo combination

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Overview of Relapse Options
· Retreat with prior therapy
· Consider combinations
· Review transplant possibilities
· Don't forget old drugs
­ Cytoxan/Melphalan
­ Adriamycin
­ Etoposide/Platinum...
Consider New
Drug Trials

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Response and Further Remissions
Response at Each Relapse
is the Next Step
in Your Ongoing Care
Time is Your Friend

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