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Low counts
Hi Jason,
If you can find some of Scuba's old posts, he discussed his problems with low counts when he started therapy and how his treatment plan evolved during that time.
I don't know if it's appropriate, but you could reach out to Dr. Cortes to see if he might give you some pointers. jcortes@mdanderson.org
I'm hoping you guys can get to a more stable and less worrisome CML situation in the new year!
Kirk
Jason,
Need more information:
1. What TKI, dose?
2. When diagnosed? current FISH and/or PCR level?
3. Blast cell count?
It's common early in treatment for myelosuppression to occur (low blood counts, neutrophils/platelets mostly affected). Some TKI's affect patients more than others. Sprycel is notorious for inducing myelosuppression especially at the higher starting doses. A typical protocol for managing myelosuppression is to follow an on again off again schedule to manage blood counts and condition the blood system. If your wife is early in treatment, there is a big transition occurring where her leukemic blood system is getting killed off and over time her normal system replaces it. This takes time (many months) and is in part why myelosuppression is observed. As long as blast count is very low (one or two percent) and ideally zero, she is in chronic phase and gives some time to experiment with dose interruption and modification.
In my case it took over 7 months of drug interruptions (lasting months) and dose experimentation to discover what works best for me. I had severe life threatening myelosuppression (Neutrophils < 0.1 and platelets < 40). During this time I had weekly CBC tests and monthly FISH/PCR tests done. I am currently PCRU and take only 20 mg Sprycel. Key is to experiment to find what works. I have confidence your wife will normalize (or get close to normal) and do well. Stay vigilant.
Some references:
http://ascopubs.org/doi/abs/10.1200/JCO.2017.35.15_suppl.e18551
http://www.bloodjournal.org/content/118/21/2761?sso-checked=true
https://www.researchgate.net/publication/26283600_Dynamics_and_Managemen...