← Back
Treatment and the treatment process

How the next option is chosen

In relapsed or resistant leukemia, the next treatment is chosen together — based on medical information and on your values.

Last updated: ~2 min read
On a dark navy background, a scale of light holding small glowing spheres of different colours.
Figure 1.The benefits and risks of each option are weighed.

01Short answer

Choosing the next treatment depends on several groups of factors. Disease factors: the type of leukemia, genetic features and new mutations, response to previous treatment and length of remission, and where the relapse is. Personal health factors: age and overall condition, heart, kidney and liver function, other illnesses, earlier side effects, and whether a donor is available. Personal values: goals, quality of life, family situation and ability to travel. A multidisciplinary team — haematologist, transplant specialist, pathologist, nurse and others — discusses this information. Then the doctor talks through the options with you, including benefits, risks and alternatives such as clinical trials and treatment focused on symptoms. This is called shared decision-making.

02Simple explanation

The disease. Genetics and previous response are considered.

The person. Overall health and organ function matter.

Values. Your goals are part of the decision.

A shared decision. You and the team choose together.

03Scientific explanation

Disease factors: ELN or protocol risk group, repeat mutation profile at relapse (FLT3, IDH1/2, NPM1, KMT2A, TP53 and others), MRD status, CD19/CD22 expression (B-ALL), BCR-ABL1 mutations (CML), and previous exposure to drug classes (CLL).

Patient factors: ECOG performance status, comorbidity indices (such as HCT-CI), organ function and fitness for intensive treatment; for transplant, whether an HLA-matched or haploidentical donor is available.

The decision process: a multidisciplinary meeting, a second opinion, eligibility for clinical trials; in shared decision-making, medical evidence is combined with the patient’s values and preferences. Palliative care can be offered alongside treatment.

04What happens in the body?

Weighing the options

Every option has benefits and risks. The team assesses them from the evidence and should explain them to you clearly.

Team discussion

Complex cases are often discussed at a joint meeting of specialists. This brings different views together.

Blurred silhouettes from behind around a softly lit round table with glowing documents in the centre.
Figure 2.Specialists discuss complex cases together.

Your values

For some people treatment intensity matters most; for others, being at home or quality of life. Say so openly — there is no right or wrong answer.

On a dark background, a delicate gold compass with its needle pointing toward warm light.
Figure 3.Your values guide the choice.

05How the decision is made

A simplified outline.

Gathering information — All results.1Gathering informationAll results.
Team discussion — Specialists together.2Team discussionSpecialists together.
Talking with you — Options and questions.3Talking with youOptions and questions.
A shared decision — The plan and next step.4A shared decisionThe plan and next step.
ClarityWhy this choice.
A personal planFits the disease and the person.
ReviewWhen things change.

06What affects the choice

GroupExamplesWhy it matters
DiseaseGenetics, previous response, timing of relapseWhich treatment may work
OrgansHeart, kidneys, liverTreatment safety
Overall healthPhysical strength, other illnessesFitness for intensive treatment
DonorWhether a suitable donor existsPossibility of transplant
PersonalGoals, family, travelA plan that suits you

* The final decision is yours, made together with the team.

07Key terms

Multidisciplinary team
A joint group of different specialists.
Shared decision
A choice made by doctor and patient together.
Performance status
An assessment of everyday abilities.
Comorbidity
Another illness alongside leukemia.
Clinical trial
A controlled study of a new treatment.
Palliative care
Care focused on symptoms and quality of life.

08Key points

  • The choice depends on the disease, the person and their values.
  • The team discusses complex cases together.
  • Ask about benefits and risks.
  • Your goals matter.
  • A second opinion is normal.
  • Palliative care can run alongside treatment.

09Frequently asked questions

What questions should I ask?

What is the aim, what are the benefits and risks, how long will it take, can I be at home, and what are the alternatives.

How long do I have to decide?

Sometimes a quick decision is needed, sometimes you can think for a few days; ask your doctor.

Can I decline treatment?

Yes, it is your right; the team will keep helping with symptom control and support.

Does palliative care mean "giving up"?

No. It eases symptoms and can be given together with active treatment.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. What questions should I ask?

  2. How long do I have to decide?

  3. Can I decline treatment?

  4. Does palliative care mean "giving up"?

My questions

12Sources

  1. National Cancer Institute (NCI). Adult Acute Myeloid Leukemia Treatment (PDQ) – Patient Version
  2. National Cancer Institute (NCI). Adult Acute Lymphoblastic Leukemia Treatment (PDQ) – Patient Version
  3. National Cancer Institute (NCI). Types of Cancer Treatment
  4. National Cancer Institute (NCI). Cancer Clinical Trials Information
  5. National Cancer Institute (NCI). Choices for Care with Advanced Cancer
  6. Cancer Research UK. Treatment for hairy cell leukaemia
  7. MedlinePlus. Hairy cell leukemia
  8. Cancer Research UK. Hairy cell leukaemia
  9. Leukemia & Lymphoma Society. Hairy cell leukemia
  10. American Cancer Society. Treating Leukemia in Children
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
Last updated: ← Back to the list

Open the interactive site →