Syria’s first lady, Asma al-Assad, has been diagnosed with leukemia, the Syrian presidency said on Tuesday, almost five years after she announced she had fully recovered from breast cancer.

The statement said al-Assad, 48, would undergo a special treatment protocol that would require her to isolate, and that she would step away from public engagements as a result.

In August 2019, al-Assad said she had fully recovered from breast cancer that she said had been discovered early.

Since Syria plunged into war in 2011, the British-born former investment banker has taken on the public role of leading charity efforts and meeting families of killed soldiers but has also become a target of contempt for many opposition supporters.

She runs the Syria Trust for Development, a large NGO that acts as an umbrella organization for many of the aid and development operations in Syria.

Last year, she accompanied her husband, President Bashar al-Assad,on a visit to the United Arab Emirates, her first known official trip abroad with him since 2011.