While there are few easy problems in medical oncology, caring for the patient with relapsed or refractory acute myeloid leukemia (AML) is among the most challenging. Patients and their families are understandably disappointed, frightened, and desperate upon learning that initial therapy did not provide the hoped for results. And their concerns are justified, as treatment for recurrent leukemia is generally far less effective than initial therapy. Further, the physician has only a limited amount of information to help in the selection of therapy since, while there are a large number of studies and review articles dealing with initial therapy of AML, far less is written about recurrent disease. There is also much greater heterogeneity among patients by the time they relapse than at initial diagnosis. Despite, or better, because of the challenges posed by recurrent AML, there are many good reasons to focus on the topic. Given our current abilities and success rates in treating de novo AML, the majority of patients with AML will eventually fall into this category. Further, although outcomes are not outstanding, many patients who have relapsed can still be cured. And finally, this is where research is most needed.

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