When you talk to your doctor about treatment for chronic myelogenous leukemia (CML), you may hear him say that your goal is to get into remission. If you're like most folks, you've got a general idea of what the term means, but you may be fuzzy on the details. For CML, you need to reach some milestones to be considered in remission, though some doctors have slightly different targets than others.
Your doctor will use blood test results to figure out which remission category you're in. He'll refer to these different groups as "responses."
Complete hematologic response. It means your blood cell count is back to normal and tests don't show any abnormal white blood cells. Also, if your spleen was swollen, it's now at its original size.
Complete cytogenetic response. You've reached this milestone when tests no longer show signs of the "Philadelphia" chromosome. That's the one that carries a gene called BCR-ABL, which plays a role in creating abnormal white blood cells.
Major molecular response. It means a very small number of cells with the BCR-ABL fusion gene are in your bone marrow or peripheral blood. What's a "very small" number of cells? It's more than 1,000 times fewer than when you were diagnosed. In this type of remission, the odds of the leukemia growing again or moving into an advanced phase are dramatically lower.
Complete molecular response. It's when no cells with the BCR-ABL fusion gene are found in your bone marrow or peripheral blood.
How Do I Know if I'm Having a Relapse?
It's likely to show up in a blood test, so it's important to see your doctor for regular checkups.
Your doctor will use the same categories he used when talking about remission to describe a relapse.
For example, he could refer to a "hematologic" relapse in your blood cell count. Or he could tell you that you've had a "cytogenetic" relapse, which means you again have cells with the Philadelphia chromosome.
He could also say you have a "molecular" relapse, which means you have some of the BCR-ABL gene in your blood or bone marrow cells.
If you have any of these changes, your doctor will repeat the test to rule out error. If a second test confirms the changes, your doctor may do a bone marrow biopsy to look for changes in the chromosomes so they can figure out what treatment might work better for you.