Remission During Chronic-Phase CML
Sujana Movva, MD
New medicines have greatly boosted quality of life for people with chronic myelogenous leukemia (CML). The goal of treatment is remission. How do you know if you’re there?
When Am I in Remission?
As your blood test results improve with medications for CML, your doctor will talk to you about the different types of responses.
“We try to be very, very specific in CML because most patients hear the term ‘remission’ and they feel the cancer is gone,” says Gail J. Roboz, MD. She's the director of the Leukemia Program at Weill Cornell Medical College in New York City. “But actually in CML there are specific categories of remission.”
CML response "milestones" include:
- Complete hematologic response -- when your blood cell count returns to normal, tests don't show any abnormal white blood cells, and your spleen goes back to a normal size if it was swollen.
- Complete cytogenetic response -- when no cells with the Philadelphia chromosome are found in your blood or bone marrow.
- Complete molecular response – when the BCR-ABL gene doesn’t show up in your blood.
- Major molecular response -- most people with CML don't have a complete molecular response. They still have a tiny amount of the BCR-ABL gene in their blood. But doctors consider this an excellent response.
“The most important milestone we’ve derived with the new treatments is the major molecular response. That’s when the leukemia is 1,000 times smaller than when we started,” says Michael J. Mauro, MD, of the Memorial Sloan-Kettering Cancer Center in New York City. “It’s a significant enough remission where the odds of the leukemia growing again or transforming into an advanced phase are dramatically lower.”
Mauro says patients generally achieve blood remission in a few weeks and cytogenetic remission in a few months. Doctors look for major molecular remission within the first year or two, and research is under way to see if treatment can be stopped after a period of time in it.
How Do I Know if I’m Having a Relapse?
A relapse is likely to show up in a blood test, so it's important to regularly see your doctor for blood work.
“We define relapse in general as ‘backward movement,’ and … the patient is unlikely to have any change in the way they feel,” Mauro says. “That’s an advantage. We can intervene when there are only subtle changes at a deeper level.”
A relapse is identified through the same categories as your remission.
You could have a:
- Hematologic relapse found in your blood cell count
- Cytogenetic relapse where cells with the Philadelphia chromosome are once again detected in your blood or bone marrow
- Molecular relapse where amounts of the BCR-ABL gene are found in your blood