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Should I switch meds if CCyR at 12 months?

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#1 Cliffee



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Posted 25 April 2012 - 08:54 PM


As I recently posted at my 9 month pcr. I was 1.4. Im on Gleevac 400mg since last July 14 2011.

I just saw my doctor Monday and he is a bit concerned since I was 1.1 at 7 months. He was pushing towards switching me from Gleevac to Tasigna. He was ok with staying on Gleevac but ended with saying if I'm not at CCyR at the 12 month biopsy he wants me to switch to Tasigna.

My 5 month BMB was 3.  I'm hoping to be zero at 12 but what if Im real close?

Gleevac has been wonderful. Absolutely no side effects at all! Changing is a scary this, especially to something with a Black Box warning label attached.

Thanks for the help!


#2 GerryL


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Posted 25 April 2012 - 11:38 PM

Hi Cliff,

Your doc is qutoing CHR not CMR. CHR is Complete Hematological Reponse or in other words your blood work is in the normal range. I would look to switching TKIs if I hadn't achieved CHR by 12 months. CHR is the first mile stone you need to achieve.

There aren't many people that I'm aware of that have got to CMR by 12 months on Gleevec - Trey being the only one I know. It took me 16 months to get there and I was diagnosed very early.

My doc is keen on Tasgina and has switched a few of his patients that are struggling with Gleevec side effects over to it. But you can't tell what side effects you may get until you try it e.g. you not having any with Gleevec.

#3 Cliffee



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Posted 26 April 2012 - 01:42 AM

Hi Gerry,

Sorry, Im not up on all the lingo just yet. I reached Complete Hematological Reponse in the first two months. All blood levels normal. His target for 12 months and I think the second milestone is no Philadelphia Chromosomes in my bone marrow (Negative). This was 3 at 5 months. I will have one on July (12 months). If Im not negatice he wants me to switch.

#4 Happycat


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Posted 26 April 2012 - 03:37 AM


Sounds to me you mean a complete cytogenetic response aka CCyR or CCR. Was that it?  Or was it a PCR test from bone marrow fluid? Or a FISH test?  Traditional cytogenetics does a karyotype of usually 20 cells to look for Ph+ chromosome. FISH uses a fluorescent marker to label the bcr-abl complex, usually on 200 or so cells.

I'm trying to figure out how you get 3.8% from karyotyping, since 1/20 would be 5%.

If there is a way to equate PCR numbers to CCR, I don't know it wel enough. I believe it is roughly equivalent to a 2 log reduction.

That said, oncologists look for CCR by 12 months, as I believe that's the guideline. (Someone correct me if wrong.). Other oncs are willing to give a little more time, usually out to 18 months, to reach that level. Up to you and onc on how comfortable you are with a longer timeline to reach CCR.


#5 PhilB


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Posted 26 April 2012 - 04:07 AM

Hi Cliff,

So many abbreviations, so many tests, so many numbers.  Everyone gets muddled some times.

The 'standard' rules (which predate the widespead availability of anything but Gleevec) say that CCyR (ie all 20 clean cells in a BMB or an equivalently low FISH) is the definition of an 'Optimal' response at 12 months.  They do, however, hope to get all the way to MMR by that point and regard not getting there as a 'warning' sign that warrants closer monitoring.  If you don't have CCyR at 12 months and the other drugs are available then, in the absence of other conditions that might make the possible side effects especially dangerous for you, trying one of the other drugs would seem like a very sensible thing to do.  You can always go back to G if you do find the others hard to tolerate so there is no need to be scared of them.

The big question is what exactly is that 3.8% BMB number you are quoting?  If it's standard karyotyping then it means they found one cell in 26 ph+ (although why they looked at 26 rather than 20 I don't know).  If it's a PCR then it doesn't tell us much as PCRs are only really useful once you get past CCyR.  If it's a FISH (ie they tested between 200 and 500 cells) then you were in an interesting grey area that many people would say was ALREADY CCyR as the normal test of 20 cells would by definition have a negative being 'below 5%'.  

Do you have copies of the actual test results for both your 3.8 and your more recent 1.1?  If you post what it says on the paper then we can tell you exactly what kind of test they both were.

Best regards


#6 Trey


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Posted 26 April 2012 - 10:11 AM

You would like to have a zero BMB (CCyR) at roughly 12 - 18 months.  There is never a wrong reason to switch drugs, but if doing well enough on Gleevec side effects wise, then switching may be ill-advised.  Oncs do not care much about side effects. 

Definitions of test zeroes:

Zero BMB or FISH = CCyR

Zero PCR = CMR

#7 Cliffee



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Posted 26 April 2012 - 10:58 AM

Thanks for all the help and Im sorry Im a bit confused on the terms. CCyR is what he was looking for at 12 months.
I copied the area on the test where I came up with 3.8. See below. I think 3 is the actual number we are looking for here?
This test was at 5 months of Gleevac.
FISH BCR Speci^1,2/14/2011 03:15 pM Bone Marrow
F I SH BCR Or d e r I 2 / L 4 / 2 0 1 1 0 3 : 1 5 pM 1 5 De c 2 0 1 _ 10 8 : 0 3
FISH BCR MethodL2/L4/2011 03:l-5 pM (NoTE)FISH for the ABL oncogene and BCR (breakpoint cluster
region) ,
FIsH BcR Reason1"2/L4/2011103 :15 pM chronic myel_ogenous leukenia/cML
FISH BCR p'esul-EL2/L4/2011 03r1"5 PM (NOTE)nuc ish(ABLX3), (BCRX3), (ABL con BCRx2) t1915001
Of 500 nuclei, 3.8t had fusion of BCR and ABL signals. The
normal cutoff is <0.6t for 1 ABL, 1 BCR and 2 BCR/ABL fusion
Chrom BM SpecimL2/L4/2011" 03:15 pM Bone Marrow
Chrom BM Order L2/L4/ 2011 03:15 PM l_5 Dec 2Ol1 08:03
Chrom BM Band ML2/L4/2011 03:15 PM (NOTE)Method Analyzed Karyotyped Band Level
ToLal 20 3 400
Chrom BM MeL}lod],2/L4/201-L 03:15 PM Culture without mit.ogens
Chrom BM p.eason1"2/142/ 011r03:1-5 pM chronic myelogenous leukemia/CML
Ch r om BM Re s u l t 1 2 / 1 4 1 2 0 L L 0 3 : 1 5 PM 4 6 , x y , E ( 9 ; 2 2 ) ( q 3 4 ; q 1 " 1 - . 2t 3) l / 4 6 , X y l j - 7 1
Chron BM Interpt2/L4/2011 03:15 PM (NOTE)The result is abnorrnal. Of 20 metaphases, 17 were normal
and 3 had a t ( 9 i 2 2 ) ( q 3 4 ; q 1 1 . 2 ) . This t r a n s l o c a t i o n i s
consistenE wiEh CML. Landstrom Ap er al., Leuk Llmphoma
47 ( 3 ) : 3 9 7 - 4 0 2 , 2006; Kal_idas et a l . , JAMA 286:895-898, 2 0 0 1 .
FISH studies for BCR and ABL are pending (reported
separaLely) .
s i g n a ] s .
FISH BCR InterpL2/L4/201L 03:15 PM (NOTE)The result is abnormal and indicates BCR/ABrr fusion in 3,89
of nucfei. This resulE is consisEenL with L]ne L(9;22)
observed in the chromosome studies (reported separaEely).
This result is usually associated wit.h CML or precursor
B-ceLl ALL. Landstrom et a1. / Leuk L)mphoma 47:397-402,
2006; Kalidas et. at. , ,fAMA 286;895-898, 2 0 0 1 .

#8 Trey


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Posted 26 April 2012 - 04:54 PM

So 3 out of 20 (5%) BMB cytogenetics and 19 out of 500 (3.8%) FISH, which are fairly equivalent.  You are doing about average, which is fine.

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