MDS Remission and Relapse

Remission

In Myelodysplastic Syndromes (MDS), remission may be permanent or temporary. Below, we explain the different outcomes patients may experience post-treatment.

Complete Remission (CR)

In order to be considered in complete remission, patients must maintain the below benchmarks for a full four weeks. Complete remission is reported to begin at the completion of the four weeks of maintenance.

Peripheral Blood:

1. Hemoglobin greater than or equal to 11 g/dL non transfused without erythropoietic support
2. ANC greater than or equal to 1000/mm3 without myeloid growth factor support
3. Platelets greater than or equal to 100,000/mm3 without thrombopoietic support
4. 0% blasts in blood

Bone Marrow:

1. Less than 5% myeloblasts with normal cell maturation in all cell lines

Hematologic Improvement (HI) 

In order to be considered in HI, one of the following must be maintained for at least eight weeks without cytotoxic therapy. Like with CR, HI is reported at the end of the eight week maintenance period.

Hematologic Improvement - Erythropoietic (HI-E):

1. Hemoglobin, untransfused, increase of greater than or equal to 1.5 g/dL
2. For RBC transfusions performed for hemoglobin less than or equal to 9.0 - Reduction in RBC transfusions needed for 8 weeks by greater than or equal to 4 units when compared to the  number of transfusions needed during the 8 weeks prior to treatment

Hematologic improvement – Platelets (HI-P):

1. Pre-treatment platelet count of greater than or equal to 20 ×109, platelet absolute increase of greater than or equal to 30 ×109
2. Pre-treatment platelet count of less than 20 ×109, platelet absolute increase of greater than or equal to 20 ×109 and greater than or equal to 100% increase from levels pre-treatment

Hematologic improvement – neutrophils (HI-N):

1. Neutrophil count increase of greater than or equal to 100% from their pre-treatment level and an absolute increase of greater than or equal to 500/mm3

No Response (NR)/Stable Disease (SD)

1. They do not meet the criteria for Hematologic Improvement, but there is no evidence of progression to Acute Myeloid Leukemia

Progression from Hematologic Improvement (Prog from HI)

In order to be considered in Progression from HI, at least one of the following must be present and have no other explanation:

1. Greater than 50% reduction from the patients maximum response levels in granulocytes or platelets
2. Reduction in hemoglobin by greater than or equal to 1.5 g/dL
3. Transfusion dependence

Recurrence

In MDS, recurrence is the result of at least one MDS cell surviving after treatment. These MDS cells then multiply and interfere with healthy blood formation. Most recurrences occur within the first two years following initial treatment.

Relapse from Complete Remission (Rel from CR)

Requires at least one of the following:

1. Bone marrow blast percentage is back to pre-treatment levels
2. Decrease of greater than or equal to 50% from the patients maximum response levels in granulocytes or platelets
3. Return to transfusion dependence or hemoglobin level greater than or equal to 1.5 g/dL that is lower than prior to therapy

Progression to AML

Patients may be given an AML diagnosis if they have greater than or equal to 20% blasts in the bone marrow or blood. See our HealthTree for AML 101 pages if your MDS progresses to AML to begin learning how best to treat and fight your AML.