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Treatment and the treatment process

Response to treatment

At set points in treatment, doctors check how the leukemia is responding. These results guide the next steps.

Last updated: ~2 min read
On a dark navy background, dim red cells fade in a bone marrow space as teal, gold and rose healthy cells fill it.
Figure 1.In remission, healthy cells fill the bone marrow again.

01Short answer

Response is assessed with blood tests, bone marrow tests and highly sensitive tests. In acute leukemias the goal after induction is complete remission: very few blasts in the bone marrow, recovering blood counts and no signs of disease. A deeper level is testing for measurable (minimal) residual disease (MRD): flow cytometry or molecular methods can find single leukemia cells among millions. An MRD-negative result is usually linked to a better outlook. In CML, response is measured by BCR::ABL1 level (molecular response); in CLL, by blood, lymph nodes and sometimes MRD. If the response is weaker than expected, the doctor may intensify or change treatment, or discuss a transplant.

02Simple explanation

Checkpoints. Results are checked at set moments in treatment.

Remission. The visible signs of leukemia disappear.

A deeper look. MRD tests search for hidden cells.

The next step. The result shapes the plan.

03Scientific explanation

Response criteria in acute leukemia: complete remission (CR) means marrow blasts below a threshold, no blasts in the blood and recovered counts; CRi/CRh are remission with incomplete count recovery. ELN criteria are used for AML and protocol-specific criteria for ALL.

MRD: multiparameter flow cytometry, quantitative PCR (such as NPM1 or fusion transcripts) or next-generation sequencing. In ALL, MRD is the key measure for risk group and treatment intensity; in AML it also affects outlook and transplant decisions.

Chronic leukemias: in CML, BCR::ABL1 on the International Scale (IS) — complete haematological, cytogenetic and major molecular response (MMR); in CLL, iwCLL criteria for complete/partial response, with MRD-guided duration in some regimens.

04What happens in the body?

What does remission mean?

After treatment the bone marrow is cleared of leukemia cells and healthy cells begin to grow again. It is a big step, but not the end of the road.

Looking for hidden cells

MRD tests find very small numbers of cells that can’t be seen under the microscope. This helps the doctor plan treatment more precisely.

A glowing magnifying lens over many calm teal cells reveals a single small red cell.
Figure 2.An MRD test finds one leukemia cell among many.

Checks along the way

Response is checked at points set in advance — for example after induction and after consolidation courses.

On a dark background, a path of light runs into the distance lined with softly glowing milestone stones.
Figure 3.Response is checked at set points on the treatment path.

05How response is assessed

A simplified outline.

Bone marrow — At the end of a phase.1Bone marrowAt the end of a phase.
MRD test — Using sensitive methods.2MRD testUsing sensitive methods.
Discussing results — With your doctor.3Discussing resultsWith your doctor.
Next phase — The plan is confirmed or changed.4Next phaseThe plan is confirmed or changed.
RemissionNo signs of disease.
MRD-negativeUsually a better sign.
Ongoing checksThroughout treatment.

06Main types of response

TermMeaningWhere used
Complete remission (CR)No signs of leukemia, counts recoveredAcute leukemias
CRi / CRhRemission without full count recoveryAML
MRD-negativeA sensitive test finds no leukemia cellsALL, AML, CLL
Molecular responseA fall in BCR::ABL1 levelCML
Persistent diseaseRemission not reachedAll types

* Only your doctor can explain what a result means for you.

07Key terms

Remission
Disappearance of signs of disease.
Complete remission
No signs of leukemia in marrow and blood.
MRD
Measurable residual disease.
Flow cytometry
A method that identifies cells using light.
Molecular response
A fall in the level of a genetic marker.
Refractory
Not responding to treatment.

08Key points

  • Response is checked at set points.
  • Remission is a big step, not the end.
  • MRD tests search for hidden cells.
  • Results guide further treatment.
  • If response is weak, there are other options.
  • Discuss your questions openly with your doctor.

09Frequently asked questions

Does remission mean "cured"?

No. Remission means no signs of disease; treatment and follow-up continue to keep it from returning.

Is an MRD-positive result bad news?

It means extra steps may be needed; your doctor will explain the options.

Why take bone marrow again?

Blood tests don’t fully show what is happening in the marrow.

When will results be ready?

Some tests take a few days; molecular tests can take longer.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Does remission mean "cured"?

  2. Is an MRD-positive result bad news?

  3. Why take bone marrow again?

  4. When will results be ready?

My questions

12Sources

  1. National Cancer Institute (NCI). Definition of complete remission – NCI Dictionary of Cancer Terms
  2. National Cancer Institute (NCI). Definition of minimal residual disease – NCI Dictionary of Cancer Terms
  3. American Cancer Society. Treatment Response Rates for Acute Myeloid Leukemia (AML)
  4. National Cancer Institute (NCI). Adult Acute Myeloid Leukemia Treatment (PDQ) – Patient Version
  5. Critical Care, 2010. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial
  6. MedlinePlus. Chronic Kidney Disease
  7. NIDDK (NIH). Kidney Disease
  8. MedlinePlus. Dialysis
  9. MedlinePlus. Diabetes Type 1
  10. MedlinePlus. Diabetes Medicines
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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