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My first blip after 4 years

Got my first blip after 4 years of PCRU (except the time I went off of the TKI to have BMB). My 0.000% has gone to 0.050%. I sort of figured this day may come. :(

Gleevec 100mg daily since 11/1/17. Gleevec 200mg daily for the year prior to that. I haven’t received the results from the doctor yet, just read the result on the patient portal. Trying to guesstimate what the doctor will have to say about it.

Gleevec is dose dependent - the higher the dose, the better it works - of course up to its toxic limit. Your 100mg dose is very very low, only 25% the clinical dose of 400mg.

You should consider switching drugs to low dose Sprycel (Dasatinib). Dasatinib is not as dose dependent - it's more of a threshold drug. Once a minimum sufficient dose for that patient is reached, it tends to drive CML into complete remission. Key here is to know what that dose is that is effective.

In your case - you are likely to have a great response (i.e. PCRU) on a minimum Sprycel dose (i.e. no side effects you can feel). You should discuss that with your doctor. Alternatively, you can go back to your 200 mg Gleevec dose.

 

I was thinking if he mentioned going back to 200mg of Gleevec, I’d ask for low dose dasatinib. What would be the lower dose? 

it occurred to me this evening that this is about the 6-month mark for my having lowered from 1/2 to 1/4 dose of Gleevec. 

Sorry to hear about the blip. I was searching for another article supporting starting sprycel at 50 for libby when I came across this one which I can't work out to copy and paste from my phone but title is:
Efficacy and safety of dasatinib 50 mg once daily dose in patients with chronic phase CML who failed imatinib. Authors Yassin, El-Ayoubi and Kanzoul

It concludes 50mg generated very good response rate in v small study ( 9 patients).

Maybe a good place to start?

best wishes Louise

Thanks Louise and Scuba for the helpful info.

4/30/18 0.050%

5/30/18 0.000%

6/11/18 0.117% (specimen taken same day as doctor visit and agreement to try dasatinib 20mg/day)

6/19/18– still waiting for specialty pharmacy to ship dasatinib!

 

ive been on low-dose prednisone. Would low-dose prednisone affect pcr?

i don’t want this to mess up any future TFR attempt.

Best of luck with the Sprycel tired blood. Great that doctor agreed to start you on 20 mg. Hopefully no side effects!