After a recent BMB, he was told he is in a "partial remission". The flow cytometry states >there are "no abnormal cells present" but there is "immunophenotypic evidence of previously >diagnosed B-cell chronic lymphopoliferative disorder." From what we understand of the >pathology, there are some "clusters" that are unidentifiable, so they can't say he is in a >complete remission.
A partial remission occurs anytime that there is a "normal" peripheral blood picture but evidence of a leukemia in the marrow . Given that - without seeing the results - my sense is that in the immunophenotyping process, there was evidence of the antigenic pattern seen in the previously described malignant cells but that this evidence was not large enough to quantify accurately. For example - suppose your malignant clone was CD308, CD250, and CD400 positive. In a normal phenotyping, these antigens should be between 10-20%. But antigens CD 250 and 400 show up at 20% although 308 doesn't appear at all. All the other clusters or patterns look ok. So you don't have a significant number of abnormal cells but you are not perfectly clear of them either. It could be because they are still wandering around or these left over pieces are the last races of the dead and dying malignant cells that just haven't been cleared out of the system yet.
In the marrow, lymphs are supposed to be in a certain architectural pattern. These clusters aren't the right pattern and apparently the cells themselves are so bizarre as to be unidentifiable. Again - there are two possible explanations - one is that the RFC so damaged them that they are functionally dead and will be cleaned up as soon as the marrow has time to do so or that they withstood the full brunt of the RFC.
As to his hemoglobin, many people find that, after the stress of chemo, they never quite return to their previous concentrations of hemoglobin or white cell counts or platelet counts. That does not mean that they are anemic - just that if 15.0 was their hemoglobin level before, they might only get back to a 14.0.
A complete remission occurs when all laboratory and other (MRI, etc.) appear to be within reference limits. That, at first, should sound just like the definition of a cure - the absence of the disease. The problem is that no test currently in use has that level of accuracy or sensitivity.
Most laboratory tests, for example can not pick up signs of a leukemia if there are less than 1,000,000 malignant cells in the body. So I can't tell if you have 0 malignant cells or 999,999 malignant cells. That's why physicians don't use the word 'cure' until 7 to 10 years later. If, in all that time, no malignancy has been noted, then you just don't have any. If a malignancy did occur in that timeframe, then probably these cells were in such low numbers that they could not be detected.