Some patients will have relapsed or progressive disease on initial presentation. Others may present with symptoms of refractory or progressive disease after a previous cancer diagnosis. Access to the best available therapies, including clinical trials, as well as treatment overseen by a multidisciplinary team, are crucial to achieving the best outcomes for anyone with relapsed or progressive disease.

Signs and symptoms will depend on the type of cancer initially diagnosed. They may be discovered by the patient or by surveillance in the follow-up care period. Symptoms can often present as:

• progressive cytopenias and presence of or increasing blasts on the blood film
• progressive fatigue
• bleeding and bruising
• recurrent infections
• increasing transfusion