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bcr-abl blood test

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Hey guys, i would like your opinion on the following: My sister (30) was diagnosed in 2012 and since then she is on Imatinib 400mg, So far she has not reached MMR, An year ago her test results were 0.38%, and 6 months ago they were 0.23%. We dont have second generation TKI in our country. Is increasing the dosage of Imatinib the only solution? And  are her results that bad?, cause as I have been reading a lot of the results that you have posted in this forum , her results look kind of  discouraging.

Hi Angela

Others may be along soon to respond to your post now Christmas and New Year have passed.  

I would say that although your sister may seem to be reacting slowly, her PCR results are moving in the right direction. Maybe an increase in Imatinib is what is required but we are all different and respond at different speeds.  The most important thing is to see the PCRs going down rather than up.

Where is she treated?

What were her PCR resutls on diagnosis ?

Are these PCRs on the international scale (IS)?

Best wishes for 2017,

Chrissie

Thank you for your reply Chrissie, Happy holidays  and best wishes!

My sister is treated in Macedonia(Europe), when she was diagnosed they only performed a qualitative bcr-abl test, not a quantative one, so the results only said that she was brc-abl POSITIVE. 

Back then the quantitative  test wasnt performed in the clinic in my country so 6 months after diagnosis  her blood was sent to Serbia for analisis, i do not recall of the result but it was pretty high. The three results i mentioned are the only ones she has done since her diagnoses(4 years ago), and yes they are in IS. The doctor says that the results are not very satisfying and if 2nd generation TKI were avaliable she would have to take those instead of Imatinib which sadly we dont have here.

Best regards, 

Angela

Hi Angela,  happy new year first of all to you, your sister, and of course everyone here.

Whilst this has been a slower response than is the guidelines, it is very encouraging to see that her numbers have fallen, and continue to do so. Your sister has cml that is responding to Imatinib and is steadily dropping it seems. Indeed a higher dose may help, but also may increase any side effects. Personally if my numbers were falling I would perhaps try one more PCR before pushing to try a higher dose, it seems likely she is due a new set of results soon as the last were 6 months ago ? I do not see her results as discouraging, and know of people that have levels above this but who’s cml remains under control. MMR – 0.1% is a very good place to be and gives a real feeling of safety, however speaking to a few doctors I have been told that reaching CCyR – 1% is a very good result as well.

Please post her latest number when it is though, all the best.   Nigel

Hi Nigel, thank you for your responce, Happy New Year and all the best to you too!

I will definetely post her next results here and ask of your opinion. In the meanwhile I do not know if its the best to increase the dose(since her Plt, Rbc, and Leu are decreasing a little bit every month and i am scared that with the increased dose of Imatinib they will decrease even more) or not. A few doctors here that i have talked to said, that if she was a patient in another country she would be given Nilotinib right away, but since we dont have it here, the only option is increasing the dose of Imatinib.

Thank you again and best wishes Nigel!