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What does it mean if you aren't PH+?

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#1 lindacarriere


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Posted 06 May 2012 - 07:30 PM

My husband was diagnosed two weeks ago and I have done a lot of reading on CML.  Have to say, there really is a lot of crap out there that makes no sense.  Here and one other website is the only place I look for answers now.  Trey, you really are a godsend to CML patients everywhere.  Thank you for doing what you do!  So, here's my question.  We don't have the complete labs back yet and still don't know if my husband is PH+.  So what if he isn't?  I have yet to find anything that tells me what the therapy and prognosis is for these patients.

#2 Trey


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Posted 06 May 2012 - 08:19 PM

Your previous posting said your husband had a WBC of 269K and was diagnosed with CML but did not yet have the Bone Marrow Biopsy report back.  So you are waiting for the BMB report to re-confirm the CML diagnosis.  I assume the initial CML diagnosis was made based on either a FISH or PCR test that indicated the presence of the Philadelphia Chromosome (Ph+).  Although this is a legitimate method of providing a preliminary diagnosis, it should not take the place of a BMB since the BMB  provides important details and confirms a final diagnosis.  The BMB establishes the CML Phase at diagnosis, looks for high risk factors, and evaluates the overall health of the marrow. 

So getting to your question, if the initial diagnosis was made based on either a FISH or PCR test, and given his high WBC (269K) then it is 99% sure the BMB will show Ph+.  So in that case, I would not worry about the issue. 

But for the inquisitive minds, there are a couple times when a BMB does not show Ph+ although the person has CML; in those cases there are a couple possibilities: 1) If the WBC is somewhere around 20K - 35K (instead of like your husband's 256K) then there might not be enough Ph+ cells in the marrow to detect by BMB procedures; 2) There is a rare Ph- CML that does not show the Ph+ chromosome;  3) Test failures happen sometimes, often due to human error.

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