During and after treatment for acute lymphocytic leukemia (ALL), you will have many tests. These tests check your blood and bone marrow for leukemia cells. They are used to see how well treatment is working. They can also be used to look for signs that the leukemia might have come back.
Terms you may hear
Your ALL might be described with one of these terms:
In remission (or complete remission)
There is no sign of leukemia after treatment.
Your blood counts are normal.
You have less than 5% immature cells (blasts) in your bone marrow.
Sometimes the term complete molecular remission or complete molecular response is used. This means that leukemia cells cannot be found in the bone marrow even with very sensitive lab tests.
Being in remission doesn’t mean you’re cured. Remission may be permanent, meaning the cancer is cured. But there's no way to know for sure how long a remission may last.
Minimal residual disease
Minimal residual disease (MRD) testing is done routinely as part of ALL treatment. It's often done after induction therapy (the first part of treatment), when it can help predict how well treatment may work.
If you are MRD positive, the ALL appears to be in remission. But very sensitive lab tests are still able to find leukemia cells in your bone marrow. These cells could become active and start to multiply. So the ALL is more likely to come back (relapse). You may benefit from more treatment to try to kill the remaining cells. Or a different treatment may be advised.
MRD negative is a good thing. It means no cancer cells can be found in your bone marrow. People with negative MRD results tend to have longer remissions, which can mean they live longer.
The leukemia has not gone away and is not responding to the current treatment. Your healthcare provider will talk with you about other treatment options. These may include more intense doses of chemo or other kinds of chemo.
Relapsed (recurrent) ALL
The leukemia went into remission after the first treatment (induction therapy), but it has come back (relapsed or recurred). Your blood counts may be abnormal again or blasts have reappeared in your bone marrow. Your healthcare provider will discuss treatment options to get your ALL back into remission.