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After treatment and remission

End of treatment and cure

After the last course, the most common question is: “Am I cured now?” The answer is not simple, because doctors use several different words — end of treatment, remission, long-term remission and cure. This topic explains what these words mean and why the goal of treatment differs between types of leukaemia.

Last updated: ~4 min read
On a dark navy background, a glowing road stretches into the distance with four shining posts spaced along it, the last in the warmest light.
Figure 1.End of treatment, remission, long-term remission and cure — different points on the same road.

01Short answer

The end of treatment means the planned courses are complete. Remission means signs of leukaemia can no longer be seen in tests. Long-term remission means this lasts for years. Cure means the leukaemia is not expected to come back — doctors use the word carefully, usually only after many years without relapse. In acute leukaemias (AML, ALL, APL), the aim of treatment is often cure; consolidation, maintenance or a transplant are there to destroy hidden cells. In chronic leukaemias (CML, CLL), the aim is often long-term control; in CML, some people can try treatment-free remission under medical supervision. The risk of relapse is usually highest in the first years and falls over time.

02Simple explanation

End of treatment — the planned courses are over. It is not yet a cure, but it is a big step.

Remission — leukaemia cannot be seen in tests. But a very small number of hidden cells may remain, so follow-up continues.

Doctors use the word “cure” carefully: it takes years to be sure the leukaemia has not come back.

Acute and chronic leukaemias have different goals: in one, removing the disease completely; in the other, keeping it quiet for many years.

Which word applies to you only your doctor can say, after looking at your tests and treatment.

03Scientific explanation

NCI dictionary: remission is a decrease in or disappearance of signs and symptoms of cancer; the definition of complete remission stresses that it does not always mean the cancer has been cured.

AML: according to the ACS, about 2 in 3 people reach remission after standard induction; after consolidation, up to half stay in long-term remission — a figure that depends strongly on age and genetic features.

Timing of relapse: the ACS notes that if AML comes back, it most often does so within the first few years after treatment; in childhood leukaemia, relapse also usually happens during treatment or in the first years afterwards.

CML: according to the ELN 2020 recommendations, some patients with a long-lasting deep molecular response can stop their tyrosine kinase inhibitor under close BCR::ABL1 monitoring; this is called “treatment-free remission”.

04What happens in the body?

Four different words

End of treatment — the courses are complete. Remission — leukaemia is not visible in tests. Long-term remission — this lasts for years. Cure — the leukaemia is not expected to return. Doctors keep these words separate so that expectations stay realistic.

The goal in acute leukaemia

In AML, ALL and APL, treatment is usually given with the aim of cure. Induction brings remission, and consolidation or a transplant is there to destroy cells that cannot be seen. In ALL, this is followed by maintenance lasting years. So the end of treatment is not halfway along the road, but the last stage of a whole plan.

The goal in chronic leukaemia

In CML, targeted drugs keep the disease under control for a long time, and many people live ordinary lives. In some, after a long and deep molecular response, stopping the drug is tried. In CLL, treatment is sometimes given for a fixed time and sometimes continued long term; sometimes long-term monitoring without treatment is enough.

On a dark navy background, two separate glowing paths: one short and steep, rising to an open door, the other long and level, running to the horizon.
Figure 2.The goal of treatment can differ between acute and chronic leukaemia.

Why are doctors cautious?

Even the most sensitive tests cannot see every cell. Sometimes MRD is negative and relapse still happens, and sometimes it is positive and relapse does not happen. So doctors look not at a single result but at the picture over time, and they do not rush to use the word “cure”.

What does time change?

The risk of relapse is usually highest in the first years and falls with every year without relapse. That is why follow-up is frequent at first and then less so. After many years without relapse, your doctor may talk with you about cure more openly — but this is always judged individually.

On a dark navy background, a clear hourglass with reddish sand running low in the top half and soft golden light gathering below.
Figure 3.The risk of relapse is usually higher in the first years and falls over time.

05From treatment to long-term remission

Each stage has its own meaning.

End of treatment — The planned courses are complete.1End of treatmentThe planned courses are complete.
Remission — Leukaemia is not seen in tests.2RemissionLeukaemia is not seen in tests.
Years of follow-up — The risk gradually falls.3Years of follow-upThe risk gradually falls.
Long-term remission — A conversation with your doctor about cure.4Long-term remissionA conversation with your doctor about cure.
Realistic expectationsYou know which stage you are at.
A clear conversationYou can ask your doctor a precise question.
HopeEach year without relapse lowers the risk.

06The usual goal of treatment in different leukaemias (simplified)

LeukaemiaUsual goalWhat the “end” of treatment looks like
AMLCureInduction and consolidation, sometimes a transplant; sometimes maintenance
APLCureTreatment usually lasts 1–2 years, then follow-up
ALLCure2–3 years of maintenance after the intensive phase
CMLLong-term controlMedicine for years; sometimes an attempt at treatment-free remission
CLLControl, life without symptomsFixed-duration or continuous treatment, sometimes monitoring only

* This is a general description. The goal of treatment depends on age, genetic features and general health — your haematologist will explain it for you.

07Key terms

Remission
A decrease in, or disappearance of, signs of leukaemia.
Complete remission
Fewer than 5% blasts in the marrow and recovered blood counts.
Long-term remission
Remission that lasts for years.
Cure
The expectation that leukaemia will not return; doctors use the word carefully.
Relapse
The return of leukaemia after remission.
Consolidation
Extra treatment after remission to destroy hidden cells.
Treatment-free remission
Keeping a response in CML after stopping the drug.
MRD
Measuring small numbers of leukaemia cells not visible by ordinary methods.

08Key points

  • End of treatment, remission and cure are different ideas.
  • In acute leukaemia, the goal is often cure.
  • In chronic leukaemia, the goal is often long-term control.
  • Doctors use the word “cure” carefully.
  • Relapse risk is higher in the first years and falls over time.
  • Statistics are about groups, not about you.
  • In chronic leukaemia, do not stop your medicine yourself.
  • Ask your question directly to your own doctor.

09Frequently asked questions

Is remission the same as cure?

Not yet. Remission means leukaemia cannot be seen in tests. Cure is only discussed after a long period without relapse.

How long before a doctor says “you are cured”?

There is no universal time. It depends on the type of leukaemia, genetic features and treatment. Usually it is a matter of years.

Why won’t my doctor say “you are cured”?

Because even the most sensitive tests cannot see every cell. Your doctor wants to be honest rather than simply reassuring. It is not bad news.

Can I ever stop my medicine in CML?

Some people can — with a long-lasting deep molecular response, on their doctor’s decision and with frequent BCR::ABL1 tests. Never do this on your own.

Treatment is over — why do I still have tests?

Follow-up helps pick up relapse and late effects of treatment early. It is there for your safety.

Is it useful to look at statistics?

For a general picture, yes, but the numbers describe groups. Talk to your doctor about your own chances.

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. Is remission the same as cure?

  2. How long before a doctor says “you are cured”?

  3. Why won’t my doctor say “you are cured”?

  4. Can I ever stop my medicine in CML?

  5. Treatment is over — why do I still have tests?

  6. Is it useful to look at statistics?

My questions

12Sources

  1. National Cancer Institute (NCI). NCI Dictionary of Cancer Terms: remission
  2. National Cancer Institute (NCI). NCI Dictionary of Cancer Terms: complete remission
  3. NHS. Treatment for chronic myeloid leukaemia
  4. American Cancer Society. Treatment Response Rates for Acute Myeloid Leukemia (AML)
  5. American Cancer Society. Living as an Acute Myeloid Leukemia (AML) Survivor
  6. American Cancer Society. Typical Treatment of Acute Lymphocytic Leukemia
  7. American Cancer Society. After Treatment for Childhood Leukemia
  8. National Cancer Institute (NCI). Chronic Myeloid Leukemia Treatment (PDQ®) — Patient Version
  9. National Cancer Institute (NCI). Chronic Lymphocytic Leukemia Treatment (PDQ®) — Patient Version
  10. Leukemia, 2020. Hochhaus A et al. European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia
  11. Blood, 2022. Döhner H et al. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN
  12. American Cancer Society. Cancer Recurrence
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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