Is response the same as remission?

So, we throw around a lot of terms in myeloma, remission, response, and it actually turns out the terms are interchangeable. So let me walk you through how we think about it. The way we evaluate somebody's response or remission is based off of that bad protein that the cancer cells make. So let's take off when you start a new therapy. If you don't go up or down by 25%, we say you have stable disease. So if your para protein, your M-spike, your free light chain doesn't go up or down by 25%, that's stable. If we decrease that M-spike by between 25 and 49%, we call it an MR, minor response or minor remission. Terms are interchangeable. 50 to 89% is a PR, partial response, partial remission. 90 to 99% is a VGPR, a very good partial response or very good partial remission. And then of course, once you start doing bone marrows and find out not just about the protein levels but the cancer cells themselves, are they completely gone, we call that CR, complete response or complete remission. We recognize that this can be a little bit confusing. Am I responding? Am I remission? Yes, even if you still have detectable myeloma protein, if your M-spike goes from 3 to 1, we'll say that you are in remission. It may not be a complete remission yet, but you're already in a partial remission and that's a wonderful thing. Another author confusion that people have, the patients and otherwise, is about the word response and the word remission. Really the word remission comes from the leukemia literature. We all accept and are used to leukemia being a curable disease that you treat, it goes away and many people doesn't come back, acute leukemia. So the word remission really comes from that literature. Many of us myeloma physicians have come from a world where we treated leukemia, so that word was very deep seeded, so to speak. The official nomenclature, the official response category does not use the word remission, it uses the word response. So you have a partial response, a very good partial response and a complete response, meaning there's no detectable myeloma protein in the blood or in the urine and the myeloma cells are less than 5% and there's still the stringent complete response. Sometimes we use remission as an unofficial term, meaning the same, the complete response. But that's not an official term. For the most part it's considered a substitute for a complete response. I go at the question a lot from patients, am I in remission? And then what I try to tell them is to explain there's different levels of response and you have a partial response or you have a complete response. And I try to emphasize the positives of it, but try to get away from using the term remission, which sometimes people misinterpret as being I'm cancer free forever, which unfortunately is not the case even for patients who get a complete response. I think we need to be very clear with what we're talking about when we discuss responses with patients because there are certain terminologies that have a totally different meaning for patients in essentially layman terms. So many patients may equate remission to cure and we do recognize that myeloma at this point is not a curable disease. We can put patients into long term remissions or responses, but the disease can come back at a later point. The same is true for other malignancies as well. So I actually have this conversation with my patients and clarify when we're talking about remission or response, we're not talking about cure, we're not talking about the disease is gone. It's been suppressed to a very low level, we can detect it, but it still can come back.