You are here

Question about PCR plateau

Categories:

I was diagnosed in October of 2015 and started 400mg of Gleevec in November.  i didn't get my first PCR until March 2016 which was 13% (IS).  My next PCR occurred in September of 2016 and the result was 0.4.  My doctor suggested then that a switch might be necessary depending on the next result.  My next test was January 2017 result was .139, again he suggested that a switch should happen even though the test was lower.  I just got my result back from April 1 which showed a .0126, again lower but looking like it's leveled off.  My question is whether or not to switch to a second generation, which I'm sure he's going to suggest or sticking with Gleevec.  I'm a little hesitant to switch just because of the unknown (I'm used to Gleevec at this point).  I guess I'm just looking for a little guidance and reassurance, and wondering which 2nd generation to go with.  Thanks

0.0126% is a great result. Why change? It took me many years to get down that low - and  I've been on imatinib for 7+ years now. It was only in Year 6 that I achieved  an extra zero down to 0.006%.

best

Chrissie

I agree with Chrissie.  

Like her, I've been on imatinib for over 7 years now and see no reason to change.  If you can tolerate the side effects and your scores are going down you are doing well.  Another consideration may be the cost.  Now that generic imatinib is available it is considerably cheaper than the second-generation TKIs, though this should not be the main reason for any decision.

Let us know how you get on.

Olivia

Sorry I made a typo it's a 0.126 for the April number. Thank you for answering

I've had a very quick response so I cant really say much but have you watched this video?

http://www.cmlsupport.org.uk/videos/how-should-cp-phase-cml-management-b...

I found it very informative when I was switched to Tasigna (from Imatanib) due to sub-optimal reponse at 3 months. I went back to Imatanib after a few weeks and had a deep response, but the video helped in my choice to revert to imatanib.

As long as your PCR's continue to improve, it would be premature to switch medicine and take on a whole new side effect profile.  The newer TKI's (Tasigna and Sprycell) are stronger and would likely reduce your PCR's more quickly, but the serious potential side effects are worse than Gleevec.  If I knew at diagnosis what I know now, I would have started on Gleevec rather than Tasigna even though I was MMR in 3 months and <.003% in 6 months.  The data I have seen suggests that there is no difference in long term survival rates between Gleevec, Tasigna and Sprycel even thought the latter 2 tend to get you to MMR and beyond more quickly and have lower incidences of disease resistance.  The only other benefit of the second generation TKI's are that perhaps they allow one to stay at MMR or better on less than full dose versus Gleevec.

By the way, if you stay at MMR or better, you will most certainly die from something other than CML.  Since you are better than MMR and PCR numbers continue to decline, why switch?  It's not a race.