Measure CLL remission from date of treatment?

[DinosaurDad]

Folks: I seem to remember that someone posted on this recently. My specific question: I thought that "remission" is typically measured from, for example, the day you're taken off medication. But I believe I saw a post referencing an article that said remission is typically calculated from date when you started treatment?

I was thinking this would be relevant especially when you look at trial results, which have calculations like PFS (progression free survival).

Maybe someone out there can help me understand?

Thank you

[Jm954 Administrator]

Hi there,

Generally, neither the start of your treatment or the end of your treatment is the date of remission. It is normally the date when investigations show you are in remission.

So, for example - start V+O in January 2022 then CT scan and then measurement of MRD in July 2022 to assess response to treatment. If there is resolution of all nodes and no disease detected then the date of those investigations (or the report) is the date of remission. That would be a CR - complete remission but sometimes there are a few nodes still slightly enlarged and a few CLL cells - that would be a PR or partial remission and the investigations would probably be repeated at a later date which could then qualify as a CR if no disease is found.

If an increase in disease is detected following a PR or CR then that is relapse and the date of relapse is the date it was detected.

Jackie

[DinosaurDad in reply to Jm954]

Thanks for your response. I did find the reference article that was quoted in the post I read recently. It speaks more specifically of the definition of PFS, and perhaps this is mainly referencing other types of cancer. Link is below.

thelancet.com/journals/lano...

I guess the key question is: when we read a study like the CLL14 study, which details PFS within a number of patient groups, PFS appears to be calculated from "randomization" - which I understand to be when trial participants are placed in test groups. See below link to a recent study results article :

nature.com/articles/s41467-...

[DinosaurDad in reply to DinosaurDad]

aha! I found the thread I was referencing:

healthunlocked.com/cllsuppo...

[AussieNeil Partner Administrator in reply to DinosaurDad]

My mistake, now corrected. I meant to say "You still need to show significantly more than a year of additional progression-free survival for each additional year of treatment, because progression-free survival is measured from when you start treatment". I incorrectly said remission, not progression-free survival.

[DinosaurDad in reply to AussieNeil]

Thanks for clarifying. You're an outstanding administrator by the way! Appreciate everything you do.

[Jm954 Administrator in reply to DinosaurDad]

In clinical trials they always use the date of randomisation, not even start of treatment because they definitely know that date for PFS. That eliminates the potential variability of the timing of the assessment of response.

[DinosaurDad in reply to Jm954]

Appreciate your feedback!

[CClaver27]

My doc initially said remission was calculated from the last treatment. But, then my next Oncologist stated it was 6 months after the last treatment since there was no residual disease present that returned. I'm not sure which one was right..