How do I know if my AML has relapsed?

So the question is how does a person know when the AML relapses? Most often we see that the blood counts change in the sense the blood counts that have recovered at the time of remission are slowly dropping back again. So if you're requiring more transfusions or you know either red cell transfusion or platelet transfusion that's usually a pretty strong warning sign. The other thing that we all do is that at least in the initial you know two to five years we do period of bone marrows. So in the period of bone marrows once the blast count is trending up particularly if it is you know beyond five percent then it's more or less a frank relapse. In the same way you can also see blasts showing up a little more persistently in the peripheral blood on your regular blood counts and that also would be an indication of relapse. The other way of looking at relapse is also what we call molecular relapse. Like some of these diseases that has a particular genetic abnormality or a particular mutational abnormality. If the genetic abnormality goes away or the mutation goes away at remission. Now when you repeat bone marrows or you're repeating peripheral blood tests some of these are showing back up again. So that would be possibly not a frank relapse but it's a harbinger of relapse that at some point and more than likely that disease is going to come back. It also has become a great tool for us to look for molecular relapse because if we can define a relapse early on that helps us to plan for the next intervention ahead of time and even before a true frank relapse happens.