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PCR-ABL Results

My husband was diagnosed with CML in Feb. of 2015. He has been on Dasatinib 80mg since diagnosis. He reached the 3.0 log reduction in about a years time, in March 2016. He see his doctor monthly and they run the PCR-ABL test monthly. Starting in April 2016, his log reduction has slowly started to worsen and decrease every month. He is now only at a 2.7 log reduction, as of June 20th. Does anyone have any experience with this? His doctor seems to be concerned and we will run the PCR-ABL again in 1 month and see if it decreases yet again.

I'm panicking because I kind of thought we were able to breath a sign of relief once he met the 3.0 milestone. Also, since reaching the 3.0 we decided to have a baby so I am now 4 months pregnant. Was not expecting results to worsen so quickly, and am pretty nervous about what it means.

Any insight is helpful! thanks!

 

I'm having a very similar experience to your husbands' right now... I was diagnosed in february 2015, achieved a 3.57 log red. (0.027%) at 11 months while taking 100mg Sprycel, I saw a locum 6 weeks ago (at the beginning of may) and my bcr-abl was stable at 3.5log red., I saw my haemo 2 days ago (21st june/15 months since diagnosis) and my log red. is now 3.07 (0.085%)!!! I had huge 'wins' in the first 11 months - I saw consistently fabulous results at every blood test... now it seems to be going pear shaped. Are these strange 'roller-coaster like' results to be expected - is this normal? I understand that everyone responds differently to treatment, but is going backwards to be expected?

Any advice or anecdotes would be greatly appreciated

Lynette x

Hi!

Sorry for the short post, but is there a reason he is on 80mg, not 100mg which is the standard dose in most cases.

David.

Hi Lynette. 

It's never a smooth ride, in my experience!

The most important thing is the overall trend, not an individual result.

Have a look at this thread, started by someone who was concerned about some of their results. Hint: that person was me!

It took me 2 years to get to MMR, and there were loads of ups and downs on the way. In my last post in that thread, I mentioned I was down to 0.4% ... some 2.5 years later and I am down to 0.008%.

 

David.

Hey David,

Thank you so very much for replying and directing me to your wonderful thread... i've found it very informative to read of your own roller-coaster results and the replies that were posted re. your concerns have been very helpful to me. 

Wishing you a fantastic friday, Lynette Black

Hi, 

Your husband's PCR result at 2.7 log reduction is between CCyR @ 1.0% and 3 log reduction or MMR @ 0.1% Bcr-Abl1. I am not used to talking in log reactions and most of us on this forum see are results reported in percentage ratios, in most cases calibrated to the International Scale (IS) as follows:

0.1% (MR3)

0.01% (MR4)

0.032% (MR4.5)

0.01% (MR5) and so on down the scale.

You can see a visual comparison of log reductions and the equivalent IS % scale on page 16 of our downloadable Q RT-PCR booklet - the link is on the right hand side at the bottom of this and other pages but I have put the link here:

see page 16  http://www.cmlsupport.org.uk/sites/default/files/qrt-pcr-primer.pdf

Your husband's clinician is doing the right thing by increasing monitoring so that he can prepare a change of therapy if test show a potential for future cytogenetic relapse. Should the next result show a continuation of a rise in levels then it is usual to test for a mutation. However, this may also be a cyclical blip which is not uncommon with PCR testing. 

It may be that there is an issue with adherence as it is know that missing more than 3 doses per month can affect optimal responses. I am sure your husbands clinician will have some answers for you should the next test also show a rising trend. There are several alternative TKIs that may well suit your husband and control his residual disease more effectively.

I hope this is helpful,

Sandy