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Bcr abl and bone marrow transplant

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Hi sandy,
After your advice I spoke to my oncologist about BMT .He told to wait for for my 3rd month pcr test.If Iam in 2nd chronic phase we may go for BMT and if the blasts are less than 10% we may continue with the current dosage of 800mg/day of Nilotinib.I had my 3rd month bmb last week .The results showed that
1>morphologically in remission with no abnormal cells
2>Bcr-abl at 2.209%(qrt pcr).

My doctor said the results was really good as I was diagnosed in blast phase with 30% blasts. I may have to go for BMT if I do not achieve zero Bcr abl by 12 month pcr test.I am going to have a second opinion with a BMT specialist this week. Kindly suggest.

I have some doubt regarding the following kindly advise
1> can I have pomegranate and oranges while on Nilotinib .I stopped taking them after my platelets dropped to 48000 and was taken out of medication for 2 weeks.my doc says it is ok to have them

2>what are the chances of my Bcr abl percentage increasing again as I was diagnosed in blast phase

Good news... you have responded well to nilotinib within the guidelines of less than 10% within 3 months. You next PCR result may well show a further drop so hopefully MMR (0.1%) before 6 months. As far as taking pomegranate and oranges (not Seville oranges used for cooking)... to my knowledge this should be fine as you do not eat anything 1 hr before and 2 hrs after with nilotinib so this would not affect the absorption of the active drug. 

I think you need to review your response over the next 3 months before you make a decision on SCT. It really does depend on what your individual CML cell 'profile' is. As nilotinib is a 2Gen TKI it may well control your CML cells for the longer term. Ponatinib is indicated well for efficacy in blast stage CML so there is that TKi as another option- as well as ABL001 (Novartis) which is still in clinical trial but showing good results.

At least you have time to consider your options depending on your response over the next months.

Sandy

Thank you for your detailed response and advice !!.I will enquire about Ponatinib and ABL001 clinical trials ,will wait for next pcr test results for SCT decision but will try to get HLA compatibility test of my brother

Thank you
Harsh

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Blast phase cml