What is remission?

What is remission? How it works is we look at the bone marrow and we're looking for these leukemia cells. Leukemia cells look like early cells, which are called blasts, and they have certain features which we can detect with something called flow cytometry. So remission is basically the absence of those cells in the bone marrow by some of this additional testing as well. So we look very deeply at the flow cytometry to see if there's any measurable residual disease. So there are different flavors of remission. A complete remission is the absence of leukemia, the return of a normal bone marrow, and basically normal blood counts. A complete remission with incomplete count recovery is a similar scenario. It's just they might not have recovered their blood counts to normal. There's also something called a morphologic leukemia-free state, and this is when we give a chemotherapy. It eliminates the leukemia cells, but also chemotherapy will eliminate normal cells as well. If those normal cells are not restored, the marrow cellularity is quite low, and so we call that a morphologic leukemia-free state. So we don't see leukemia cells, but we also don't see a lot of normal bone marrow either. Now it's becoming even more important to determine remission at the deepest level. And what we mean by deep is how low can we detect it? So we have a terminology called measurable residual disease. Some might call it minimal residual disease. I like measurable because it has to do with our limits of detection. And we know that the best remission is one where we can't detect the disease at even the lowest level. So there is a remission which is called a measurable residual disease positive complete remission. Those patients we can still take the transplant, but it has implications down the line. So the remission we're really shooting for is a measurable residual disease negative complete remission. At the end of the day, when I'm sitting with a patient and talking with them, our goal is remission. All those little nuances, that's for me to figure out what's best for them and help guide them through that process.