Moreover, the frequency of del(17p) increases with successive relapses, suggesting in vivo selection and resistance of del(17p) + cells to therapy [ 9].
Successive relapses can reduce the degree and duration of the following remission, worsen disability, and increase refractoriness to future treatment [ 8, 42].
In contrast, temperate strains are associated with a long latency period until first relapse (of the order of 6 months) followed by short intervals between successive relapses (Coatney et al., 1950; Hankey et al., 1953; White, 2011).
Although the initial therapy for indolent NHL is associated with high response rates, the majority of patients will eventually relapse, with successive reductions in the length of response to each salvage regimen.
Prior to the development of novel biologically based therapies for multiple myeloma, relapses after successive treatment regimens resulted in progressively shorter response durations [ 1], which in part reflected the occurrence of drug resistance.
We know from previous surveys that ED are frequently comorbid with Major Depressive Disorder, Anxiety Disorders and Substance or Alcohol Abuse [ 49] and also that ED relapses and successive hospitalizations reduce the response to treatment of comorbidity [ 50, 51].
They are characterized by a chronic course of the disease with successive therapies upon occurrence of relapse.
The St Gallen Consensus Conference [ 48] has also established successive classifications of risk for relapse based on clinical and pathologic features, including HER2 status in its last version.
The study included patients over the age of 18 with a suspected diagnosis of locally recurrent or metastatic breast cancer, either at first relapse or after successive disease progressions, between December 2009 and March 2011.
