Remission During Chronic Phase CML: Watching for Relapse
Keeping on Top of Your CML
CML isn't like other conditions; you can't just take a few pills and make it go away. Treating CML is a life-long effort. You have to keep taking medicine to keep your blood cells in the normal range.
Throughout your treatment, your doctor will monitor your CML with these blood and bone marrow tests:
- Blood cell counts to check the levels of white blood cells, red blood cells, and platelets.
- Cytogenetic tests to look for the abnormal CML chromosome (the Philadelphia chromosome) in a bone marrow sample.
- Fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR) tests to look for the abnormal bcr-abl gene in your cells.
You'll be seeing a lot of your doctor in the early part of your treatment. "When they're first diagnosed, depending on what their blood counts are and how they're feeling, I'll sometimes have my patients come in every week to 10 days," Roboz says.
Your doctor will have you return for PCR and FISH tests about once every three months, and cytogenetic tests every six months. These blood and bone marrow tests will help your doctor fine-tune your treatment. "Based on the results, the treatment will either be intensified or continued as scheduled," says Markus Müschen, MD, head of the leukemia and lymphoma program at the University of Southern California Norris Comprehensive Cancer Center.
Once you have achieved a complete response, you'll return to your doctor's office at least once every six to 12 months for tests.
When Am I in CML Remission?
The term "remission" isn't the same in CML as it is in other cancers. "CML patients often don't refer to themselves as 'in remission' or 'not in remission,'" Roboz says. "They'll tell you much more specifically what their cytogenic and molecular responses have been."
Here's what each CML response means:
- A complete cytogenetic response means that no cells with the Philadelphia chromosome can be found in your blood or bone marrow.
- A complete molecular response means the PCR test can't detect any of the bcr-abl gene in your blood. 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. This is called a major molecular response. Doctors still consider this to be an excellent response.
- A complete hematologic response means your blood cell count has returned to normal, and tests don't show any immature white blood cells. Also, your spleen has returned to a normal size if it was enlarged.
Unlike with other cancers, a full response, or "remission" doesn't mean that you're cured and can stop treatment. Even if tests can't find any trace of CML in your cells, the disease can relapse.