Relapsed and Refractory Disease: What It Means for Blood Cancer Patients

• Despite oncologists’ best efforts, blood cancers sometimes come back or don’t respond to treatment. People with leukemia, lymphoma, or multiple myeloma can develop what’s called relapsed or refractory disease.

  Michael Styler, MD, a hematologist/oncologist at Fox Chase Cancer Center, has the answers to some common questions about relapsed and refractory disease in patients with blood cancer:

  What are relapsed and refractory diseases?

  Relapsed disease means a cancer has come back. Refractory disease means a cancer has stopped responding to treatment.

  “Most hematologic cancers, like leukemia, lymphoma, and multiple myeloma, are initially very sensitive to treatment. Patients very commonly go into remission when we treat them,” Styler said. “But ultimately, there may be some cancer cells that are just inherently resistant to those treatments, and over time, they start to multiply and the disease comes back again. At that point, it’s actually quite resistant to standard therapy.”

  What is the difference in relapsed and refractory disease for each kind of blood cancer?

  Relapsed and refractory disease can be different depending on the type of blood cancer:

  • With leukemia, people who have been in remission can have a return of cancer cells and a decrease in normal blood cells. This is a relapse. Patients who still have cancer cells in their bone marrow after treatment have refractory leukemia.
  • Relapsed lymphoma is a disease that responded to treatment initially, but then returned. Refractory disease means the cancer hasn’t responded to the initial treatment (it could be getting worse or staying the same).
  • With multiple myeloma, almost all patients will experience a relapse or will see the disease become refractory.

  How are relapsed and refractory blood cancers treated?

  Relapses and disease that isn’t responding to treatment can seem dire, but at Fox Chase, effective treatment options are available.

  “We can often overcome it by treating patients with very high-dose chemotherapy,” Styler said. “We pick drugs that we can safely increase the dose of, and we know will cause the patient to experience damage to their bone marrow cells.”

  That might sound dangerous, but there’s a workaround to this damage—a stem cell transplant.

  “To get around that side effect, we use stem cell transplant,” Styler said. “When the patient comes in for their treatment, they get the high-dose chemotherapy with the goal of trying to kill off those very resistant cancer cells. Then, we re-infuse the stem cells as a sort of rescue. This allows the patient’s cell counts to recover much more quickly and makes the whole process much more tolerable.”

  Why Choose Fox Chase?

  Our team of oncologists and bone marrow transplant specialists has been treating patients with relapsed and refractory disease for many years, offering the latest therapies and clinical trials.

  “We have a very mature transplant program that is ranked very highly. It’s a multidisciplinary program with physicians who dedicate themselves specifically to transplants and taking care of patients undergoing transplants and cellular therapy,” Styler said. “We perform 100 to 150 stem cell transplants each year, and we’re pleased to offer many clinical trials. Our patients have access to the most recent advances and most promising treatments.”

  Learn more about Fox Chase’s Department of Bone Marrow Transplant and Cellular Therapies