MORTON COLEMAN, MD: John, we usually refer to relapse as a term connoting a return of disease after the initial response. Refractory disease usually connotes a term which means that the disease never fully responded, either it progressed-and we call that progressive disease-or that the disease did not respond fully.
Very often, patients will respond in a complete manner. that's known as a complete remission. Those patients who come out of that sort of response is considered a relapse, whereas patients who don't fully respond, or where the disease continues to grow, those patients are considered to have refractory disease.
JOHN LEONARD, MD: So why is that an important distinction for a patient, as far as sorting out whether they responded and relapsed or whether the disease didn't respond at all?
MORTON COLEMAN, MD: It may have great relevance with regard to the sensitivity to therapy. Those patients who relapse tend to, from a complete remission, tend to be more sensitive to the subsequent therapy. It's more difficult to treat patients who have not fully responded or who have progressive disease. It probably connotes some form of resistance to treatment.
JOHN LEONARD, MD: One of the unusual things about indolent lymphoma as compared to other sorts of tumors is the fact that patients often don't need treatment, either at the time of diagnosis or at the time of relapse. And that can be a very complicated decision, as to deciding whether or not to initiate treatment or not.
Dr. O'Connor, how do you, as you approach your patients, how do you make that decision? What are some of the factors that you think about in deciding whether or not you need to start treatment for an individual patient?
