What is the difference between stringent complete response (sCR) and complete response (CR)?
I am unclear on this. My husband reached sCR after four months of cyclophosphamide, Velcade (bortezomib), and dexamethasone (CyBorD).
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
Re: Stringent complete response (sCR) vs. CR
Hi dogmom,
A Complete Response (CR), sometimes called a complete remission, means a patient has:
No M-spike +
No signs of a monoclonal protein on either a serum or urine immunofixation test +
No extramedullary plasma tumors (plasmacytomas) +
Less than 5 percent plasma cells in the bone marrow.
A Stringent Complete Response (sCR), sometimes called stringent complete remission, means that the patient has
All the criteria for a complete response +
A normal kappa-lambda serum free light chain ratio +
No signs of abnormal (clonal) plasma cells in the bone marrow using standard methods ("immunohistochemistry) to detect such abnormal cells.
These definitions have been in place for a while. In fact, in putting together this answer, I formatted it similar to what Ian posted a while back here in the forum.
These response definitions were tweaked a bit recently, but the general idea is still the same. In case you or others are interested, the precise definitions for each of the two responses, quoting almost verbatim from the recent paper with the new myeloma response criteria, are:
Complete Response:
Negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and less than 5 percent plasma cells in bone marrow aspirates.
Stringent Complete Response:
Complete response as defined above, plus a normal serum free light chain ratio, and absence of clonal cells in bone marrow biopsy by immunohistochemistry -- i.e., kappa-lambda ratio less than or equal to 4-to-1 (4:1) or greater than or equal to 1-to-2 (1:2) for kappa and lambda patients, respectively, after counting at least 100 plasma cells (see note directly below).
Note: Presence/absence of clonal cells on immunohistochemistry is based upon the kappa-lambda ratio. An abnormal kappa-lambda ratio by immunohistochemistry requires a minimum of 100 plasma cells for analysis. An abnormal ratio reflecting presence of an abnormal clone is a kappa-lambda ratio of more than 4-to-1 (4:1) or less than 1-to-2 (1:2).
Source: Kumar, S., et al, "International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma," Lancet Oncology, Aug 2016 (abstract)
A Complete Response (CR), sometimes called a complete remission, means a patient has:
No M-spike +
No signs of a monoclonal protein on either a serum or urine immunofixation test +
No extramedullary plasma tumors (plasmacytomas) +
Less than 5 percent plasma cells in the bone marrow.
A Stringent Complete Response (sCR), sometimes called stringent complete remission, means that the patient has
All the criteria for a complete response +
A normal kappa-lambda serum free light chain ratio +
No signs of abnormal (clonal) plasma cells in the bone marrow using standard methods ("immunohistochemistry) to detect such abnormal cells.
These definitions have been in place for a while. In fact, in putting together this answer, I formatted it similar to what Ian posted a while back here in the forum.
These response definitions were tweaked a bit recently, but the general idea is still the same. In case you or others are interested, the precise definitions for each of the two responses, quoting almost verbatim from the recent paper with the new myeloma response criteria, are:
Complete Response:
Negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and less than 5 percent plasma cells in bone marrow aspirates.
Stringent Complete Response:
Complete response as defined above, plus a normal serum free light chain ratio, and absence of clonal cells in bone marrow biopsy by immunohistochemistry -- i.e., kappa-lambda ratio less than or equal to 4-to-1 (4:1) or greater than or equal to 1-to-2 (1:2) for kappa and lambda patients, respectively, after counting at least 100 plasma cells (see note directly below).
Note: Presence/absence of clonal cells on immunohistochemistry is based upon the kappa-lambda ratio. An abnormal kappa-lambda ratio by immunohistochemistry requires a minimum of 100 plasma cells for analysis. An abnormal ratio reflecting presence of an abnormal clone is a kappa-lambda ratio of more than 4-to-1 (4:1) or less than 1-to-2 (1:2).
Source: Kumar, S., et al, "International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma," Lancet Oncology, Aug 2016 (abstract)
Re: Stringent complete response (sCR) vs. CR
Thank you Terry. But which is better?
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
Re: Stringent complete response (sCR) vs. CR
Dogmom,
A stringent complete response is a deeper response than a complete response.
Deeper responses are associated with longer times to relapse.
Also, for a given treatment regimen and length of treatment -- for example, 6 cycles of CyBorD -- getting a deeper response not only typically means a longer time to relapse. It also typically means longer overall survival.
Best of luck to your husband.
A stringent complete response is a deeper response than a complete response.
Deeper responses are associated with longer times to relapse.
Also, for a given treatment regimen and length of treatment -- for example, 6 cycles of CyBorD -- getting a deeper response not only typically means a longer time to relapse. It also typically means longer overall survival.
Best of luck to your husband.
Re: Stringent complete response (sCR) vs. CR
Thank you Terry. This clears it up for me 
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
Re: Stringent complete response (sCR) vs. CR
HI all,
I have read this other thread in the forum with great interest,
"Does a deeper response mean longer overall survival?" (started Sep 14, 2016)
and I am wondering whether most myeloma patients even know whether they are in stringent complete response (sCR), or if they are minimal residual disease (MRD) negative.
I ask because my husband achieved a complete response (CR) last fall, based on negative serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE) and a normal free light chain ratio, but he has not had urine testing, bone marrow biopsy, or any scans since diagnosis.
Can you make a determination based on serum IFE alone?
Do doctors typically give additional tests to determine sCR, or is a blood test enough?
Thank you.
I have read this other thread in the forum with great interest,
"Does a deeper response mean longer overall survival?" (started Sep 14, 2016)
and I am wondering whether most myeloma patients even know whether they are in stringent complete response (sCR), or if they are minimal residual disease (MRD) negative.
I ask because my husband achieved a complete response (CR) last fall, based on negative serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE) and a normal free light chain ratio, but he has not had urine testing, bone marrow biopsy, or any scans since diagnosis.
Can you make a determination based on serum IFE alone?
Do doctors typically give additional tests to determine sCR, or is a blood test enough?
Thank you.
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lwem - Name: Laurie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 68
Re: Stringent complete response (sCR) vs. CR
Hi Laurie,
I suggest you read through Table 1 in the PDF that Ian links to in this post.
You need to have a serum, urine, and bone marrow biopsy test to correctly determine CR or sCR per the IMWG standards.
I suggest you read through Table 1 in the PDF that Ian links to in this post.
You need to have a serum, urine, and bone marrow biopsy test to correctly determine CR or sCR per the IMWG standards.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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