Your doctor tells you your multiple myeloma is in remission. But what exactly does that mean? The first thing to understand is that being in remission is not the same thing as being cured.
The National Cancer Institute defines cured cancer as having “no traces of cancer after treatment and the cancer will never come back.” Remission is different. It means there’s a decrease in or disappearance of the symptoms of your multiple myeloma.
Doctors rarely, if ever, consider multiple myeloma to be “cured.” Some cancer cells will likely always remain in your body. Whether you’re in remission depends on how many of those cells are there.
Most people with this type of cancer will go through several periods of remission and relapse (when symptoms of the disease come back). Ideally, treatment for multiple myeloma puts you into remission. If you relapse, your doctor will likely try a different treatment.
The period of time between relapses varies from person to person. But for many, the first remission can last 2 years or more.
Multiple Myeloma Remission Criteria
Doctors base your remission on how well you respond to your treatment. This is why it’s also called your “response.” To understand how you’re reacting to treatment, your doctor will order tests such as:
- Blood tests
- Pee tests
- MRI scans
- PET scan
- CT scan
- Bone marrow tests
- X-rays, including full-body ones called skeletal surveys to check for bone damage
The different signs, or markers, your doctors look for in these tests include:
Lytic lesions or fractures. Lytic lesions are areas of bone damage. Pathological fractures are bone fractures caused by multiple myeloma.
M-proteins (myeloma proteins). These proteins come from malignant myeloma cells. Blood and pee tests show the levels of these proteins in your body. When you have active multiple myeloma, your M-protein levels are high.
Free light chains. Light chains are proteins made by plasma cells – the cells in your bone marrow where multiple myeloma starts. These cells use some light chains to make antibodies (these become “bound” light chains). Others go into your bloodstream (these are called “free” light chains). There are two types of free light chains, kappa and lambda. Doctors look at the levels of each in your blood to monitor your multiple myeloma. In your pee, this marker is called the Bence-Jones protein. If the ratio of the two types of free light chains is out of balance, it’s a sign of multiple myeloma.
Myeloma cells. If your doctor tests your bone marrow, they’ll look for myeloma cells there.
Measuring tumors. Your doctor can use imaging tests to see if any tumors have grown or shrunk.
Types of Remission
There’s more than one type of remission. It comes in varying levels, including:
Partial response. If you’re in partial remission, it means doctors still see some markers of cancer in your body. Any tumors will have shrunk and you’ll have fewer cancer cells present. But you may still be having some cancer symptoms.
Doctors call it partial remission when:
- M-proteins are down by 50% or more
- Free light chains (Bence-Jones proteins) have dropped by 50%
- Plasma cells in your bone marrow have gone down by 50%
- If you had a tumor, it has shrunk by at least 50%
Very good partial response. In this level of remission, you have a higher response than a partial response, but aren’t yet in full remission. This usually means levels of your markers have dropped by at least 90%.
Full or complete response. This means your doctors haven’t been able to find any M-proteins in your blood or urine, and any tumors you had are gone. Your bone marrow cells may still be up to 5% myeloma cells.
Stringent complete response. If you have no M-proteins in your blood, normal free light chain ratios, and no myeloma cells in your bone marrow, your doctor may classify your remission as stringent complete.
Minimal residual disease negative. This means your doctors used more sensitive testing, such as flow cytometry or DNA sequencing tests, to look for myeloma cells in a sample of 1 million cells and didn’t find any. You need a bone marrow biopsy for these tests.
It’s hard to predict how long remission might last. Your doctor’s goal with your treatment is to extend remission so that you have long periods between treatment times. If your cancer comes back, it’s called relapsed or recurrent multiple myeloma.
What Are ICD 10 Codes?
You might have heard of rankings for multiple myeloma remission and relapse called International Classification of Disease codes (ICD codes). Insurance companies use these to classify your remission for billing and reimbursement purposes. Myeloma remission and relapse codes start with “ICD 10.”
Your ICD 10 code will vary, based on the stage of your cancer and its traits. The types of codes include:
- C90. This is the overall classification for multiple myeloma and abnormal growth of malignant plasma cells.
- C90.0. This is the overall classification for multiple myeloma. Within this code, you might be:
- C90.00: Not in remission
- C90.01: In remission
- C90.02: In relapse
Other forms (subtypes) of multiple myeloma have other codes, such as:
- C90.1. Overall classification code for plasma cell leukemia. Within this code, you might be:
- C90.10: Not in remission
- C90.11: In remission
- C90.12: In relapse
- C90.2. Overall classification code for extramedullary plasmacytoma (plasma cell tumor outside the bone marrow). Within this code, you might be:
- C90.20: Not in remission
- C90.21: In remission
- C90.22: In relapse
- C90.3. Overall classification code for solitary plasmacytoma (plasma cells in the bone)
- C90.30: Not in remission
- C90.31: In remission
- C90.32: In relapse
