I met with Dr. Cortes this morning at MD Anderson to review my recent lab work and progress to date. I finally received my workup from my bone marrow aspiration taken a few weeks ago on the 11th.
There is no presence of the Ph+ chromosome in my bone marrow that they can detect cytogentically. I went from 100% Ph+ in May to Zero as reported today.
In addition, they reported 'normal' maturation of cells. There are still abnormalities that Dr. Cortes told me he sees all of the time as the Marrow clears out the Ph+ chromosome. He expects those to decrease or disappear as well. In combination with my PCR dropping he said I am on my way. I asked him about getting to PCRu and he told me that it doesn't matter. It is the cytogentics that tells the story. He told me I might get to 0.01 or so, but as long as it stays down and I have zero bone marrow expression my prognosis is excellent. But I pressed on the PCR = 0.000 and he again said that there is no zero. It just gets lower and then becomes background to the normal population (Trey is going to love this one). He said experimental work they are doing on PCR testing with much higher sensitivities show many more false positives (i.e. bcr-abl transcripts present) giving them concern. This is a topic for another thread.
What I want to report here to all of you is what else he told me about what they are learning about Dasatinib in particular. He believes the 100 mg. that is the normal dose is way too high. He starts NO ONE at 100mg. His highest starting dose is 70mg. and then he only keeps them there if no side affects. I was part of a large trial this past year (ended today) on side affects, dose and response rates. And this study found that high dose = numerous side affects (no surprise), but that they are also seeing no side affects for those patients below 40mg. They are in the workup stage on response rate and are encouraged. Dr. Cortes has many patients (100's) on 20mg having the same response as me - some with better response. He believes 20-40mg. of Spyrcel will prove to be very effective (and recommended) along with much less side affects. He is preparing papers on this to be presented.
He is maintaining my dose at 20mg. and told me that if I get to PCRu and maintain it for two years (minimum), he will take me off Spyrcel and monitor me (as long as I feel comfortable with that. Hell yeah). What a change in view after just one year.
He also told me that although I was diagnosed in May 2010 - that as far as he is concerned, I just started meaningful therapy in the first week in May of this year when I was able to stay on therapy continuously and they could monitor the Marrow reaction. So he said that I went from 100% Ph+ in May to zero in seven months. That's what he likes to see.
We discussed Curcumin - and he is trying to get funding for an extensive trial. I asked him if I should modify my Curcumin regimen and he said, "Why mess with what's working. Keep doing what you are doing". I told him then I will continue my wine and cigar regimen also - and he didn't want to hear about that.