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What’s the Difference Between Myeloma Response and Remission?

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Published on December 15, 2017

What exactly do myeloma response and remission mean? Dr. Gareth Morgan and Dr. Faith Davies and Dr. Frits van Rhee of UAMS Myeloma Institute and Dr. Guido Tricot of University of Iowa Health Care discuss the differences between response and remission. Our expert panel also explains the correlating treatment regimen that helps you gain long-term control over your myeloma disease.

This town meeting is sponsored by Amgen, Janssen Pharmaceuticals and Takeda Oncology. It is produced by Patient Power in partnership with the UAMS Myeloma Institute.

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University of Arkansas for Medical Sciences Myeloma Center

Transcript | What’s the Difference Between Myeloma Response and Remission?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Female Speaker:

What is just remission compared to complete remission, or is it the same thing?

Jeff Folloder:     

Great question.

Dr. Morgan:         

Great question. Over to you, Dr. Davies.

Dr. Davies:           

We bat ideas and comments around like this. So, there’s remission, there’s response, as you say there’s complete remission, complete response, partial; there’s actually a set of I guess guidelines which are used internationally so that we can all judge a patient’s response to treatment in the same way. And it gets based on what happens to the M component, what happens to the bone marrow in myeloma, and what happens to the imaging. But essentially what we’re saying is when a patient is in a remission, they’ve had a good response to their therapy. If you have a complete remission, that means that we can’t see any myeloma there. 

As you were saying earlier, some patients can actually be in what we call a minimal residual disease, or MRD complete remission; and that means even with very sensitive tests we can’t see any myeloma there. But essentially from a doctor’s perspective, we’re trying to get the patient into the best response or the best remission we can, because that’s usually when the disease is quiet.

Dr. Tricot:            

Can I add? 

Jeff Folloder:     

Oh, sure!

Dr. Tricot:            

When people are in complete remission, they often ask why do I need any further treatment; I’m in complete remission. But people need to understand that when they are diagnosed, they have about a trillion myeloma cells. When they are in complete remission, they still can have up to a billion myeloma cells. And if you don’t do anything else anymore, it’s only a matter of time before you’re back to your trillion. So you really need to go down much, much lower if you want to have a chance of long-term control of your disease. 

Jeff Folloder:     

Makessense.

Dr. van Rhee:      

I would like to make one other point for whoever listens who is not in complete remission, or who is MRD positive. The real world is probably a little bit more complicated than black and white being in remission. There are certain subgroups of myeloma where we know they are frequently positive for minimal residual disease testing. Or they have some myeloma visible still under the microscope, or a low M component. 

These patients do extremely well and have equal outcomes with good treatment. So although in general terms we want to eradicate the last myeloma cells in everybody. There are certain subgroups where this may not necessarily apply, so do discuss your MRD testing with your doctor and ask what it means for you individually.

Dr. Tricot:            

 We should remember the lesson that we had from total therapy were there were patients that lived for longer than 15 years. And half of those patients who lived for longer than 15 years never achieved a complete remission. They went back into an MGUS type of state and were fairly stable, but they never went to a complete remission.

Jeff Folloder:     

So I think what you’re saying is we shouldn’t necessarily worry about the label; we should worry about how we’re living.

Dr. Tricot:            

It depends. If you have low-risk disease and you still have a little bit of disease left, that’s clearly much less of a problem than if you have high-risk disease and you have a little bit left. Those patients that have high-risk disease, they really need to get into a complete remission. Otherwise, they’re going to relapse quickly.

Dr. van Rhee:      

That’s where Brian comes into the picture. It’s not only the detection of cells, but it’s what are thesecells going to do.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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