herinductie

Herinductie refers to a second induction chemotherapy course given after relapse or failure to achieve remission following an initial induction treatment, with the goal of re-establishing remission to allow subsequent consolidation, such as stem cell transplantation. The concept is used primarily in hematologic malignancies, including acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), and can be considered in some relapsed lymphomas or other high-grade hematologic diseases depending on biology and fitness.

Indications for herinductie depend on disease type, time to relapse, overall health, organ function, and prior therapy. It is most commonly considered in relapsed or refractory disease where a second remission is attainable and where patients are eligible for further consolidation. Decision-making incorporates disease genetics, prior responses, and patient preferences, with careful evaluation of risks and potential benefits.

Approach and planning involve choosing a salvage chemotherapy regimen tailored to the individual, which may differ from the initial induction. Regimens are designed to maximize the chance of a second remission while considering cumulative toxicity. Response is typically assessed after one or two cycles through clinical examination and bone marrow evaluation. If remission is achieved, consolidation strategies such as high-dose chemotherapy with stem cell transplantation are discussed. If response is inadequate, alternatives may include different systemic therapies, targeted agents, clinical trials, or palliative care.

Outcomes vary widely and depend on disease, relapse timing, and patient fitness. While some patients regain remission after herinductie, the prognosis is generally less favorable than after the first induction, and long-term success often relies on successful consolidation. Risks include cytopenias, infections, organ toxicity, and treatment-related mortality, necessitating close monitoring and supportive care.