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Genzyme for PCR Testing : Opinions?


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#1 LivingWellWithCML

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Posted 21 October 2011 - 05:10 PM

Anyone get their PCR testing done through Genzyme?  Any opinions on how good their process is (and how sensitive) as compared to others out there?


Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg


#2 Susan61

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Posted 21 October 2011 - 06:14 PM

Sorry Dan, but never heard of Genzyme.  Why are you asking?



#3 Trey

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Posted 21 October 2011 - 07:41 PM

I did at first.  They are a major lab.  They are now part of LabCorp, which I believe is one of the largest cancer diagnostics labs in the US.



#4 LivingWellWithCML

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Posted 22 October 2011 - 08:19 AM

As I move forward, I'm debating whether to use my local onc for ongoing FISH/PCR testing, but her office sends everything out to Genzyme.  I was just wondering how sensitive their testing is as compared to .... say ... Dr. Druker's office.  I was also wondering if there's a downside to having your blood overnighted to Genzme for testing.  At Emory, my blood is walked across the street for FISH/PCR; less opportunity for degradation, etc.


Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg


#5 LivingWellWithCML

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Posted 23 October 2011 - 12:48 PM

Hey Trey,

Since you started with Genzyme, how good would you say their PCR sensitivity is?  I keep in touch with a CMLer who gets his PCR testing done close to home and is PCR-U, then he goes to Dr. Druker annually and the OSHU machine actually detects some minimal residual disease, so clearly there are sensitivity differences in the industry.

Your take?


Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg


#6 Trey

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Posted 23 October 2011 - 01:26 PM

There is not much variation among PCR equipment and chemical reagents used at major labs, although small labs could be an issue.  It was more of an issue 10 years ago than today.  Now most are about the same for the major labs.  Variations are more likely due to difference in time from blood draw to testing.  The OHSU time should be shorter.  The sooner the test, the more BCR-ABL RNA that remains viable, which is especially an issue when a person hovers around the "nearly PCRU" level.



#7 LivingWellWithCML

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Posted 23 October 2011 - 01:49 PM

That makes me think that it'd be best to keep all PCR testing at Emory, since testing is done on-site.  If you go with Genzyme, then blood will need to be overnight'ed for testing and could be impacted and/or degradated en-route, yes?


Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg


#8 Trey

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Posted 23 October 2011 - 08:02 PM

Sample degradation starts within the first hour, and within the first 24 hours the sample can degrade by as much as 50%.  A degraded sample reads lower by PCR, however, there is not a one-for-one relationship regarding sample degradation and PCR results.  But shipping time definitely has an impact on PCR results.  FISH is not so critical because the test does not "grow" the RNA.  But for PCRs, local is better, if it is a good lab.  But for most people, I would not spend time worrying about this issue.  Just be aware that this is one reason why the PCR results can bounce around a bit even if the CML is on a steady decline.



#9 Susan61

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Posted 23 October 2011 - 10:17 PM

Hi:  I go to my local Quest Lab to get my blood drawn, and then it is picked up and taken to the lab for testing.  I was told to never go on a Friday, because the sample will sit all weekend.  I have been doing my blood work like this for the past 13 years, and its not tested right at the site where it is drawn.

Isn't that the way most are being done?

Susan



#10 reedgirl

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Posted 24 October 2011 - 03:56 PM

Susan,

   I hear, or rather read, on here other times that one should not have their blood tested on Fridays.  Greg goes to U of M to see Dr Talpaz.  His appointments are always on Fridays, that's one of the days the dr sees patients.  Of course, they always do a blood draw. Should we be concerned he is not getting a good, true, result???  I wonder why the dr schedules patients on that day and why they would do lab work on Friday's if they just leave them sit all weekend.

  Thanks in advance for any clarification/advice,

  Audrey



#11 LivingWellWithCML

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Posted 24 October 2011 - 04:16 PM

I heard the same re: Fridays, and my specialist only takes appointments on Fridays as well.  So I started scheduling my blood draws 1.5 weeks in advance -- on a Wednesday.  Given how quickly these samples deteriorate, though, it's hard for me to believe that a world-class facility would just let blood samples sit idle through a weekend.  Is that really what happens, or is it more of an urban myth?


Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg


#12 Trey

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Posted 24 October 2011 - 06:36 PM

Audrey,

If the PCR is done onsite at U of M, and they do it the same day, then all is well.  If they let it sit until Monday, that is not good.  Ask Dr Talpaz how the process works.



#13 Guest_billronm_*

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Posted 24 October 2011 - 07:05 PM

Hi Audry and Greg and that must be your beautiful daughter you have a very good looking family.

   That's a lovely family picture. You reminded me I better organize one. We are way overdue.

Most of the time I get my labwork done here in Fairview Pa. It's just a couple miles from my house. But when I have to get a bcr-abl test I have to make sure I go on Thursday or even earlier. They told me that sample is only good for six hours. So they can't let it sit. The same thing applys to holidays. When I go to the cc center about 10 miles away they do bw anytime.I think it's probably because they have a lab on the premises so it gets processed right away. Right now I have a few problems with my blood (nothing serious) but then I go to the cc center.for my monthly bw. If it's the standard cbc. I just go up the road in Fairview. Sounds like a superman movie doesn't it? OMG isn't that where desperate housewives live? I'm moving. With interest rates down and people selling thier houses at much less than thier worth. It's a really nice middle class subdivision, and all these new people are moving in I'm sure most of them are lovely people but we have had 3 home invasions I don't know how many drug raids.One day this guy up the street was walking all over the neighbor hood with a loaded rifle and his family is chasing him he wanted to kill himself. He even got in his car and drove on a main highway then he came back and was running around with the rifle again. The State Police were there but they aren't used to that kind of action. God bless them they put thier lives on the line every day  But it was more like the keystone cops.They just aren't used to that type of thing around here. I'm not either and I am really ticked off because I can't go skinny dipping in the pool at night. And Ron put motion lights up all around our back yard. So I can't take 3 steps without setting one of them off. And our little dog doesn't bark at anything except Ron and I. She'll make bacon and eggs for an intruder but if we do anything out of the ordinary she barks at us. She went blind 2 years ago so we baby her even more she has us well trained but we are the only one's she barks at. Oh you guys you gotta love country living. Pretty soon I'll go to bed with my 22 pistol? is that what they call it? and something even smaller a 45 whatever so I will go to bed and sleep safe and sound and protect my family, and if I try not to repair things with duct tape Ron said he will teach me how to use them. Oh he's still a little squirmish after the circular saw incident. That was a long time ago. He didn't mind me cutting down a huge bush with a jig-saw but I'm not allowed to cut a 2x4 in half. I can't tell you how many times I had to run to the hardware to buy new blades to cut down that stupid ugly bush. He spent a year in Viet-Nam in the jungle but he is more afraid of seeing me with any kind of tool in my hand electric or otherwise.  lol Billie



#14 Susan61

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Posted 24 October 2011 - 10:09 PM

Hi:  If they are testing the blood right there after its drawn, then its okay.  The problem with going to a outside lab is that they just draw it, and it goes into a bag to wait for pick-up at some time of the day.  Then it does sit until Monday most likely to be tested.  I would never trust the reading in that case, especially a PCR.  The girl right at the lab where I go told me she would not even draw a PCR on a Friday because of the process.

     I have never gone on a Friday.  I usually go first part of the week, and my results are back by Wed or Thurs. 

Susan



#15 Susan61

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Posted 24 October 2011 - 10:17 PM

Hi:  I always go for my blood work a week before my doctors appointment, this way when I go into the office for my exam the doctor can go over my results with me in person.  Then I make sure I get a copy of my test results to take with me.  When I go for my blood work every 3 months, but do not have to see the doctor I call the office 3days after my blood is drawn and have them fax me a copy.  I do not want her reading certain values to me over the phone.  I want to see the whole thing myself. They always do what I ask.  That is the best way to follow along with your progress, and you have copies already in case you nee them for another doctor etc.  I just got my 3 month result faxed to me the other day.  Another thing I do not like, is that they do not call if they feel its all normal.  I want to see it myself.  I worked in the medical field for years, and we were a very professional office.  Every patient got a call with every test they had even if it was normal.  We were busy as heck, but our patients got excellent care.

Susan



#16 Susan61

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Posted 24 October 2011 - 10:25 PM

Hi Billie:  Sounds like a crazy neighborhood.  You are so right about not knowing who is buying up these houses.  We are getting a lot of people from up North Jersey buying down here by me in South Jersey, because the houses are cheaper.  It used to be so beautiful around here, and now I hate to say it but we are getting some real odd people that we never had before.  You be careful, and be glad that your husband is so conscious of everything around you.

All my neigbors are really nice, and most are still the original people who bought their house when I did back in the 70's.  I have been fortunate right where I am, but its the outskirts of my town that is getting big changes.  We eventually are going to have to sell, just to go smaller and cheaper to survive.

Take Care

Susan



#17 Tedsey

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Posted 24 October 2011 - 10:55 PM

I have a question about the BMB and sample degradation.  There is a note on my report last Aug. that the sample was improperly preserved, thus degraded.  Nevertheless, it appears the pathologist was able to get a full report from that sample. 

The report stated that my blasts had increased.  And the pathologist said she caught tons of red and some white cells in their beginning stage.  Since I am pancytopenic, she wrote that this was probably the reason for the increased blasts.  However, if the BM sample was degraded, wouldn't it show in inaccurate blast count if blasts were present?  I guess this has been chewing away at me because my PCR increased too (peripheral, not BMA).  Guess only time will tell and hoping it is that "bounce" Trey talked about.  Just wondering if Trey or anyone had an opinion on how much accurate information can be gotten from a degraded or "improperly preserved" bone sample.  And where does the pathologist look for blasts, (in the aspirate or what clings to the bone sample---clearly, I'm confused)?

Teds  



#18 GerryL

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Posted 25 October 2011 - 01:45 AM

Hi Teds,

Not that I'm much help here, but for both BMBs I was unable to get a PCR result due to degradation of the sample. All my PCRs have been conducted on peripheral blood. We only have two major collection agencies here and the one that I use appears not to be able to store the sample correctly? They were able to provide information on everything else though.

Sending good vibes your way for your next lot of results.



#19 Trey

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Posted 25 October 2011 - 09:24 AM

Teds,

There are usually two samples taken during a BMB process.  One is the core sample with bone chip, and one is the aspirate, which are put into two different tubes.  So I don't know whether both degraded, but apparently the core sample part did to some degree.  The aspirate tube has a type of preservative in it that helps slow down the degradation.  Also, the BMB process of viewing the 20 cells is not so dependent on viability of the cells unless they have broken down as cells or the DNA has broken apart.  The PCR must grow the RNA so it requires viable cells and DNA/RNA, but the BMB only views the cells as they are.  So if the lab was able to view the cells, then it should be accurate (and they would report if they were unable to view the cells).  Blast count likely came from the core sample, and degradation should not affect the count as much.  Blast count is usually higher at the bone edge where the sample is taken and can often be seen in sheets as they are produced.

Your Onc saw the blasts and attributed it to the very low blood counts, showing that your body is trying to recover.  That is what I have tried to impress on people here, that with very low blood counts (pancytopenia) there should be an increase in blasts -- good blasts that are trying to make more good WBCs (non-leukemic WBCs).  We have noted that some Oncs have rushed to put chemo into people when they see this increase in blasts and start them on a transplant track, despite the severe low WBC and negative BMB/FISH.  I believe that is very, very bad practice.  After the chemo, it is not possible to know what happened.  (Note: Just to be clear, BJ is NOT in this category.)

So overall, you seem to be slowing breaking out of your long struggle with very low counts, which is very good to see.






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