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my wife test reports

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dear madam,

my wife recently  cml on 20-01-2016.

she was on imatinib 400mg daily. 

on 20-04-2016 sampled PCR test report .

we cannot understand the report please explain.

bone marrow   BIOPSY  ; blast 1%

impression: hypocellular bone marrow

REPORT QUANTITATIVE RT-PCRfor Monitering M-BCR/ABL1 mRNA TRANSCRIPTS

bcr/abl copy number          1975

abl copy no                           14765.5

international scale convertion factor       1.857

international scale normalised copy no          24.83%

kryotype: not possible due to unavalability of qualty metaphases

INTERNATIONALscale normalized copy number % 0.05      MMR

INTERNATIONALscale normalized copy number % 0.15         NO major molecluer respons

0.05  INTERNATIONALscale normalized copy number % 0.15     : GRAZY ZONE ARROUND MMR CUT OFF

IS-NCN is nagative- no fusion transcript were detected

 detection limit of this assay  :     0.001% bcr/abl1 (p210)NCN 

and she was bone pain ;tramadol and acetoamenophen taking daily one tablet 37.5 and 325 mg is there any problem?

 

 

 

Hi, it is difficult to interpret this report. It seems the report says that there is no major molecular response but then goes on to say there are "no fusion transcripts - (Bcr-Abl1 )- detected".  

Has your wife's clinician told her which of the results in this report refers to  the % of Bcr/Abl generated by the test? Is it this one:- 

international scale normalised copy no   24.83% ?

It seems from this report that the sample was good as she has Abl transcripts (a normal gene) at a level over 10,000 transcripts so it should have generated a trustworthy qPCR result.

abl copy no   14765.5

I am sorry that I cannot advise further unless you have the actual % number of Bcr-Abl transcripts detected by the test. 

If I am correct in assuming that the qPCR result is 24.83% (Bcr-Abl1), at 3-4 months since diagnosis/start of therapy then you might want to discuss the idea of changing TKI therapy from imatinib to one of the 2nd generation TKIs such as nilotinib, dasatinib, bosutinib etc. depending on access issues where you are based.

Otherwise she may want to wait for the results of a second qPCR result- you do not say when this will be but it should be within the next month - again depending on the centre where she is treated. 

I advise that you talk to her clinician and ask for a clear explanation of the actual result and if she should consider a change in TKI. 

If she has been taking painkillers to help with side effects this should not cause too many problems as you indicate she is not taking a very high dose. You really should ask for advise from her clinician.

I hope this has been of some help,

Sandy