The timing of relapse is clinically important. In general, patients whose disease returns earlier have poorer outcomes than those whose disease returns later. The concern is not that timing should be ignored, but that the policy turns one prognostic factor into an automatic pass-or-fail rule.
Modern evidence shows that a patient’s prospects are affected by several connected factors, including disease status, response to treatment, performance status, other health conditions, previous transplant complications and the timing of relapse. The evidence does not establish that 12 months is a validated universal point below which no patient could benefit. Several modern studies instead identify relapse within the first six months as a particularly adverse factor and support assessing risk across a range of clinical characteristics.
