Does Remission Mean Cure for CLL?

Remission means that CLL is not detectable in the body (blood, bone marrow, or lymph system) using highly sensitive tests. After a period of time (at most 5 years), CLL resurfaces requiring follow-up treatment to achieve another remission. Current non-chemo targeted therapies are effective at helping most patients achieve long remissions (interview with Dr. Alvar Alencar, MD, from the University of Miami, FL). 

Cure means that CLL is completely gone from the body and does not return. For patients looking for a cure, it is recommended to enroll in CAR T-cell therapy clinical trials. CAR T-cell therapy is a treatment option that helps enhance the patient’s own cancer-fighting T-cells to destroy cancer cells. Two of the first CLL patients treated with CAR T-cell therapy are still disease free 10 years later. For more information about CAR T-cell therapy and enrolling in clinical trials see here: What is CAR T-cell Therapy? 

Types of Remission 

Complete Remission (CR)

Complete remission means all signs and symptoms have disappeared temporarily, but cancer may still be present.

In order to be considered in complete remission for CLL, a patient must have all of the following:

1. No evidence of swollen lymph nodes or organs (lymphadenopathy and organomegaly, respectively)
2. White blood cell counts greater than or equal to 1.5 × 109/L
3. Platelets greater than 100 × 109/L
4. Hemoglobin greater than 11 g/dL
5. Lymphocytes less than 4 × 109/L
6. Bone marrow less than 30% lymphocytes
7. Absence of other CLL symptoms including extreme fatigue, fever, night sweats, unexplained weight loss, frequent infections

Partial Remission (PR)

Partial remission means that while cancer signs are still present, treatment is working as the number of cancer cells have decreased.

In order to be considered in partial remission for CLL, a patient must have all of the following:

1. Greater than or equal to a 50% decrease in peripheral blood lymphocyte count from the patient's counts before they were treated
2. Greater than or equal to a 50% reduction in the swelling of lymph nodes if they were swollen before the patient was treated
3. Greater than or equal to a 50% reduction in liver and/or spleen size if they were swollen before the patient was treated

Along with all of the above, one of the below must also be present:

1. White blood cell count greater than or equal to a 50% improvement over the patient's baseline
2. Platelet count greater than a 50% improvement over the patient's baseline
3. Hemoglobin greater than a 50% improvement over the patient's baseline

Progressive Disease (PD)

In order to be considered in a progressive disease state, a patient must have one or more of the following:

1. Greater than or equal to a 50% increase in the size of 2 or more lymph nodes. At least one lymph node must be 2 or more cm
2. Greater than or equal to a 50% increase in liver or spleen size from the patient's baseline, due to swelling 
3. Greater than or equal to a 50% increase in absolute lymphocyte count from the patient's baseline to greater than or equal to 5 ×109/L

Stable Disease (SD)

In order to be considered in a stable disease state, a patient will not meet the requirements of CR, PR, or PD. They will not see any change in their condition.

Relapsed/Refractory CLL

Relapsed CLL is when the disease has progressed to a point that no longer meets the requirements of complete or partial remission. Patients may also hear about refractory CLL. Refractory CLL is when treatment is not effective and the disease progresses within 6 months of treatment. 

There are promising treatment options for relapsed/refractory CLL patients such as CAR T-cell therapy (currently in clinical trials for CLL). To read about the effectiveness of CAR T-cell therapy for high-risk CLL patients and how to join clinical trials, see here: CAR T-cell Therapy Emerging as a Promising Treatment for Relapsed/Refractory and High-risk CLL. Other treatment options a patient's doctor may discuss include options in this article: Non-Chemo Treatment Paths for CLL Patients

Talk with your CLL specialist about the best treatment path for your case of CLL. Need help finding a specialist? Visit HealthTree's CLL Specialist Directory.