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BCR-ABL increased after switching from Dasatinib to Imatinib

hi, Everyone,

I just had my latest BCR result,  not looking good, it went up from 0.25 to 0.48.  I was diagnosed Sep last year.  The first 6 months I was on Glivec, BCR was 426% on 14/09/14, then 37% on 26/11/14, and 0.74% on 10/03/15.  Then my doctor switched me from Imatinib to Dasatinib, I was on Dasatinib for 3 months, the BCR was 0.33% on 04/05/15, 0.25% on 14/07/15.  Because of the heart problem (pelptation) induced by Dasatinib, I requested to be put back on Imatinib.  Then the latest BCR result went up to 0.48% on 19/10/15.   My specialist said it could be a glitch from switching medication. I will do another bcr test in two months, if still going up, then my doc will do mutation check.   I am very worried at the moment.   Should I stayed on Dasatinib, but my heart pounding problem occurs all day around, especially at night, can not have a good sleep when I was on Dasatinib.  Hope someone can give me some advice. 

Thanks,

William

Hi William

There could be a number of reasons why this has happened. It may be helpful to know why you changed back to Imatinib when your doctor changed you as the results were not going in the right direction and also did you take a break between treatments (which may have caused the slight rise)? Did you have your heart checked to confirm it was the medication causing you the problems? I would be concerned that you had gone back to Imatinib when you were taken off it as your counts were rising.

K

hi, Karen,

Thanks for your reply.  I requested to switch back to Imatinib from Dasatinib because I have developed severe heart problem (pelptation) after being treated by dasatinib for one and half month.   Since then I never had a good night of sleep.  We have done some tests on my heart showing nothing wrong, but the problem persists.  It is definitely caused by dasatinib as when i switched back to imatinib the heart problem disappear straight away.  I met a fellow cmler who has exactly the same sympton also taking sprycel.   Besides, I felt that imatinib was doing fine when my doc ordered switch (bcr 0.74% at 6 months, below 1% target).  Since then I have consulted with two other cml specialist who also agreed that the switch was unnecessary at the time as bcr was heading the right direction.   I have not miss any doses, but I was taking antacid (Nexium) to treat stomach problem.  I suspect that might interfered with sprycel and imatinib. For a while I don't feel hungry no more, and I don't feel like eating.  I have stopped antacid since.  Anyway, I will just have to wait and see the next result in two months time. 

Thanks,

William

William, do take a look at Dr. Milojkovics' presentation/slides outlining the side effects caused by the different TKIs. see link here : www.mpdmeetings.org/london-conference-2015/

Her presentation (with video) was during the afternoon session from  2 - 2.45pm. Her presentation was quite in depth so it might help you understand the possible risks and how they relate to your individual case. I would say that palpitations are quite uncomfortable at the best of times and can really interfere with your ability to relax and sleep- do you have a reasonable level of Haemaglobin? In my experience if HGB is in the lower ranges it can be one of the causes of this effect. You might try supplementing with magnesium and also check your potassium levels are optimal. 

Hope you next PCR result shows you are responding well to imatinib. 

Sandy

hi, Sandy,

I went through the presentation for side effects as well as some others, they are really helpful to me.   However, I notice heart problem is not really emphasized in the Dasatinib side effects.  I have come across quite a few posts in this forum mentioning heart problem while taking sprycel.  I have also met a fellow cmler whose on sprycel that has the same problem (heart pumping) in the local cml meeting.  I believe that this is not a rare side effect for Dasatinib.  It is certainly worth further investigation as cardio problem can be potentially fatal.  And it causes more agony as its ongoing.  I am just curious to find out how many people in this forum has experienced heart problem while on sprycel, and how they dealt with this problem?  My doctor's explanation is sprycel speeds up blood circulation therefore causes fast than regular heart beats and other heart conditions.

regards,

William

hi, Sandy,

I forgot to mention my HGB is hopping around the lower limit 120-130.  My white cell is quite low between 1.8-3.  My potassium and magnesium level are at normal range, but my phosphate level is quite low at 0.68. 

William

HI William,

Low HGB may well be the cause of your heart increase heart rate- although is this an increase that has been measured by your clinician or is it something you 'feel'? I am not sure about dasatinib increasing the blood flow being a reason for this side effect! All TKIs have an increased risk of causing cardiac problems- imatinib, dasatinib and bosutinib less so than nilotinib and ponatinib according to the data. You need to ask your doctor to test your heart rate just to set your mind at rest. Other than that I think you need to check your diet and increase foods that will raise your HGB.

Best... Sandy