Remission Duration

Remission duration, as the name suggests, is reserved only for patients who achieve CR, and is calculated from the date CR was attained to the date of relapse. For patients who die without a report of relapse, remission duration is censored at the date of death, regardless of the cause. Finally, for patients whose disease does not relapse, remission duration is defined until the day the patient was last seen. This is the only measure, of the above four, as defined by Cheson and colleagues,1 subject to competing risks (e.g., death without relapse).

Category

Proposed follow-up for adult ALL patients How?

How often?

Category

How often?

Remission status

Ask about constitutional symptoms and symptoms of anemia, thrombocytopenia, and granulocytopenia

Every month during the first year, every 3 months for the second and third years posttherapy, and then at least every 6 months for 3 years

Remission status

Look for pallor, petechiae, lymphadenopathy

Every month for 1 year posttherapy, and then every 3 months for 2 more years, and at least every 6 months for 3 years

Remission status

Complete blood count with differential

Every month for 1 year posttherapy, and then every 3 months for 2 more years, and at least every 6 months for 3 years

Remission status

Bone marrow aspiration and biopsy for morphology and cytogenetics

Once, 3 months post completion of chemotherapy, and then no specific guidelines, unless on clinical trial

Remission status

PCR for specific chromosomal aberrations

No specific guidelines

Remission status

PCR with patient-specific junctional regions of rearranged immunoglobulin or T-cell receptor genes

No specific guidelines

Remission status

Flow cytometry to detect specific phenotypes

No specific guidelines

Avascular necrosis

Ask about pain in hips while walking

With each history taking as mentioned above

Heart failure

Ask about swollen ankles, shortness of breath, etc.

With each history taking as mentioned above

Sterility

Ask about pregnancies

With each history taking as mentioned above

Hypothyroidism

Ask about cold intolerance, fatigue, somnolence

With each history taking as mentioned above

PCR, polymerase chain reaction.

PCR, polymerase chain reaction.

Other definitions of outcomes have been used in clinical trials.1 For example, when postremission therapy was studied, all patients had to be in a CR at the time of enrollment, and therefore time until relapse or death should be measured from the date of study entry following CR.

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