When is a CR not a CR?

[biopearl123]

Answer: 1. When there is a recurrence of disease. 2. When there is a cure. With chronic diseases like MF and MDS and with acute diseases like AML and blast phase CML remissions are a good thing. Only problem is that the disease recurs even when the bone marrow or blood clears to the point of meeting remission criterion. Why? Minimal residual disease. (MRD) that is hard to detect but still present. For a cure every malignant cell must be wiped out. A tall order. What constitutes a cure? One definition is absence of disease for 5 years. AFAIK, this has only been accomplished with bone marrow transplantation. As we approach EHA, at last sighting, Geron reported sustained TI in 30 % of patients. Are theses patients CR's? Is there evidence for MRD in these patients? As we approach EHA and see abstracts that presumably update the MDS P II durability data perhaps some of these questions can be answered. If there is MRD detectable, is there a strategy short of BM transplant that might address those remaining malignant cells? One can only hope. For EHA,there is probably not much more data to wring out of the MF P II study at this point but we know that a handful of patients remain on Imetelstat in the PII MDS study. Some had dramatic reductions in mutation burden. Where to now? (Besides the PIII data). May should be interesting. As Jesse Jackson said, "keep hope alive". bp

[Ryan]

Excellent summation - however the ‘5 year’ definition is certainly not a rule and more a rule of thumb. It also varies by disease. For instance with breast cancer, I’m sure many of you know of someone who was in remission for more than 5 years only to have it return, I sure do.