What are the treatment options available for isolated extramedullary relapse of an AYA patient with AML following HSCT?

This is such a tough situation. Unfortunately, when a patient relapses after the second stem cell transplant, options are limited because a third transplant is rarely feasible and cure is not likely with medication alone. One could consider a Phase I trial if available and the patient is eligible. One could also consider options to control the disease in a way that allows a decent quality of life, but would not be considered curative. Hydroxyurea, a hypomethylating agent, and venetoclax are all examples of things that can be given outpatient and may (or may not) slow progression. Depending on where the extramedullary disease is located, palliative radiation therapy could be considered. I wish I had better suggestions.