The intent and nature of treatment will depend on the location, extent of relapsed or refractory disease, previous management, comorbidities and the patient’s preferences.

In managing people with relapsed AML, anti-leukaemia treatment may include these options:

• intensive re-induction – chances of success are better after a longer duration of the first remission and can be estimated using the European Prognostic Index (Breems et al. 2005)
• enrolment into a clinical trial – trials evaluating the use of novel agents should be strongly considered
• allo-SCT
• irradiation of infiltrative/mass lesions (solitary chloromas) and craniospinal irradiation in the event of central nervous system disease
• regular transfusional support with red cells and platelets should be administered where appropriate.

If treatment is given with curative intent, the facilities need to be of the same level as for the initial therapy. Palliative chemotherapy may be delivered in a less specialised environment. Allo-SCT must be delivered only in specialised units with appropriate accreditation as well as human and physical resources.

The potential goals of treatment should be discussed, respecting the patient’s cultural values. Wherever possible, written information should be provided.

Encourage early referral to clinical trials or accepting an invitation to participate in research.