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Question about starting Sprycel and Labs

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I started 100mg/day Sprycel last Friday and my Doc said he didn't want any blood work done until 6 weeks of Sprycel. I never had a problem with my counts on Gleevec, but it seems like the prescribing information (see below) is saying a CBC should be done at two weeks. Am I missing something, or should I have a CBC before 6 weeks? For those of you who switched to Sprycel, how often did you get a CBC when you started on it?

You've got a great site here!  Thanks for hosting it!

 

Here's my history:

09/2012   p210 transcript 118.7% IS @ Dx, begin Gleevec 400mg/day

12/2012   003.59% & bone marrow biopsy - no residual myeloproliferative features but detected 1/20 metaphases containing the Philadelphia chromosome

2013   000.914%,  000.434%,  000.412%  10/2013  000.360% & bone marrow biopsy - normal male karyotype with no evidence of a clonal cytogenetic abnormality

2014   000.174%,  000.088%,  000.064%

2015   000.049%,  decrease to Gleevec 200mg/day,  000.035%,  000.061%,  000.028%

2016   000.041%,  000.039%,  000.025%

2017   000.029%,  000.039%, switched to generic imatinib 200mg/day,  000.070%,  000.088%

2018   000.233%,  switched to dasatinib 100mg/day - I want zero #4 back!

 

5 WARNINGS AND PRECAUTIONS 5.1 Myelosuppression Treatment with SPRYCEL is associated with severe (NCI CTCAE Grade 3 or 4) thrombocytopenia, neutropenia, and anemia, which occur earlier and more frequently in patients with advanced phase CML or Ph+ ALL than in patients with chronic phase CML.

In patients with chronic phase CML, perform complete blood counts (CBCs) every 2 weeks for 12 weeks, then every 3 months thereafter, or as clinically indicated.

In patients with advanced phase CML or Ph+ ALL, perform CBCs weekly for the first 2 months and then monthly thereafter, or as clinically indicated. Myelosuppression is generally reversible and usually managed by withholding SPRYCEL temporarily and/or dose reduction [see Dosage and Administration (2.5) and Adverse Reactions (6.1)].

I was diagnosed in advanced chronic stage: 5% blasts, enlarged spleen, myelofibrosis (bone marrow test was a dry tap!); CML had started approximately 2ys before, as a retrospective analysis of previous blood test suggested. So not really advanced, but doctors where quite worried it was getting there.

So I started out with 140mg sprycell.

Given the context, I had blood tests every 5 days. Platelets were initially low but they recovered after a cautionary 5 days break; then neutrophiles dropped. Yet doctor was optimistic, because platelets were showing my bone marrow was recovering, so no more breaks, but great caution as far as the environment was concerned (no mall or crowded places for me).

Eventually everything was back in check. But, to answer your question, if I had gone unmonitored for 3 weeks, I would have probably ended up on a hospital bed...

Of course myelofibrosis was mostly to blame, but 3 weeks without a blood test seem a but overoptimistic.

Cheers,

Davide

 

Hi Kirk - welcome to the U.K. CML site.. It is very well organized and designed by patients for patients. It should become the global resource for CML.

It's very important you get CBC done weekly for the first 3 weeks or even longer to verify your blood counts are stable.

You want to watch for falling Neutrophils, platelets or red blood cells in particular. 100 mg Sprycel is potent. 

Hi Kirk! It’s been my experience that with every change in TKI, whether dosage or type, I’ve always gone back to weekly labs. After they’re stable for 6 weeks, then to monthly, etc. Given the information you already have, at the very minimal, at least every two weeks. Hopefully, your doctor will re-consider. 

Melanie 

I suppose it's different everywhere. I dropped from 100mg to 70mg of dasatinib, so increased PCR tests from once a quarter to every six weeks. I don't think weekly, or even monthly monitoring would have been appropriate in my case. Realistically, what's going to really radically change?

David. 

Kirk I think you should at a minimum have a blood test every 2 weeks if not weekly for the first 6 weeks.  I believe Sprycel is a much more potent drug than Gleevac. Also it will help your peace of mind and that loudly beating heart if you do. Everything reacted as it should for my husband - WBC fell from 220k to 16 k in one week and red cells started to respond as well but I think others have experienced big drop in platelet counts. So better to be safe than sorry ! 

This site feels much more like the old message board. A good new home :) 

best Louise 

"Realistically, what's going to really radically change?"

In one week, my neutrophils dropped from 1.2 to 0.3 - dangerously low. I had to have a drug break until my counts recovered which took weeks.

Starting a new drug - especially Sprycel, should have CBC monitored weekly until a new baseline is established. It took months in my case with weekly blood tests until I stabilized.

When my Neutrophils fell to 0.1, I was told to go immediately to the emergency room at the first sign of a fever - and not to wait until the next day, it was that dangerous.

This was so many years ago. Now, I haven't had a blood test in five months!

When I said "what's going to really radically change" I meant in my particular case of going from 100mg to 70mg of dasatinib. Seems a pretty safe change that wouldn't warrant weekly monitoring. 

I'm not suggesting someone who is taking dasatinib for the first time should be monitored on the same basis!

David.