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Question PCR and FISH


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#1 Johnc

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Posted 24 March 2013 - 09:01 AM

I have a question - Started Gleevec

* diag 4/12

   4/12 -pcr at diag - 105%(IS - I converted it from non IS)

    7/23/12 pcr 100% slight -0.0256 log reduction(Blood cleaned up Nicely)

     9/4/12 pcr - 27.32%(IS) -0.56 log reduction

Started 100mg of sprycel with reduction to 70 mg with two drug breaks totaling 8 weeks between the two pcr dates

     2/15/13 pcr 2.34%(IS) -1.63 log reduction

My question is I found out my FISH(from Bone Marrow NOT Blood) was 20/20 on 2/15/13 at the same time I had a -1.63/-0.54(Blood/Marrow) log reduction. Both test were taken during a recent 5 week drug break. How can the blood PCR going in the right direction but the FISH in the wrong direction occur.(I am sure blood and marrow are different and the drug break did not happen. How close in general are the Marrow and Blood PCR numbers?

I am definitely a slow responder but the Onc who specializes in BMT, I finally talked onc down to 50 mg of Sprycel(the next dosing if Blood keeps tanking) but no lower but wants to begin the BMT process at my next apt on April 1. Also, I made it clear and onc. concurred, plans are no more drug breaks, I am ready for the shots and Platlets to keep my ANC and Platelets up.

I also have an apt with Dr. Talpaz on April11(My 1 year diag. anniversary - opefully a good Omen), thanks to CallMeLucky suggestion and Dr. Talpaz has written to me and says his plan are accomplished with no BMT.

Any Questions or Comments are appreciated.

Johnc



#2 hannibellemo

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Posted 24 March 2013 - 10:03 AM

Johnc,

I'm sure there are those who will give you more technical responses but I am very glad to see that you are getting a second opinion from a CML specialist. I would be very surprised if you did not have a much better response by staying on the drugs (whichever one it ends up to be) instead of taking all of those breaks. You may find you aren't such a tortoise, after all!

Gleevec was much harder on my counts than Sprycel turned out to be. I was quite surprised. Although, it has taken nearly 4 years (the most recent one of those at 50mg. due to pleural effusion) to get my counts back in the low normal range.

God luck!

Pat


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"You can't change the direction of the wind but you can adjust your sails."

DX 12/08; Gleevec 400mg; liver toxicity; Sprycel 100mg.; CCyR 4/10; MMR 8/10; Pleural Effusion 2/12; Sprycel 50mg. Maintaining MMR; 2/15 PCRU; 8/16 drifting in and out of undetected like a wave meeting the shore. Retired 12/23/2016! 18 months of PCRU, most recent at Mayo on 7/25/17 was negative at their new sensitivity reporting of 0.003.<p>


#3 Trey

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Posted 25 March 2013 - 09:02 AM

When there are rapid changes, the marrow tells you first.  Otherwise they are roughly equivalent when things are stable.



#4 Johnc

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Posted 25 March 2013 - 07:16 PM

Trey

My fish was at 20/20  but my PCR was down quite a bit. Would those not tend to follow each other to some degree?

Thanks,

Johnc



#5 Trey

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Posted 26 March 2013 - 09:10 AM

You said the FISH was marrow and PCR from blood.  So as I said, blood can lag marrow results when things are changing rapidly.  That can be part of it, but also PCR is not as accurate at the higher levels.



#6 Melanie

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Posted 28 March 2013 - 01:03 PM

Johnc,

I've had similar issues with conflicting Fish and PCR results...especially during low dosage and drug breaks.  I'm convinced and my doctors agree that it's the marrow measurement that's you pay the most attention to at first. Once you have 0/20, then the PCR test becomes more valuable.  Haven't made it there yet myself, but working on it.  

I'm also convinced that the most TKI you can get in you, without taking a drug break, is the best course of treatment. Finding that balance is the hard part.  Those of us who are sensitive to being myeloid suppressive, the guidelines state to hold the meds until your counts recover.  The hope being that it's just a temporary thing that your body will adjust to.  In some cases that plan doesn't work, even after many drug changes and drug breaks, so we're left with considering a BMT or some other treatment plan that's not as common.

I'm glad you're seeing Dr Talpaz, for I'm sure he has more experience with cases like yours and probably has a treatment plan that's a better alternative than BMT. In my case I consulted with Dr Cortes who coordinates with my local Onc. My plan now is to stay on my TKI (Bosutinib in my case) and treat the cytopenias with transfusions and shots. For the platelets, I'm going into a clinical trial for Etrombopag, which isn't approved for CML, but is used for low platelets in chemo treated patients. I'm only on 40% of Bosutinib, but we will increase dosage slowly as BMB will allow.

Hope this helps and praying you have an encouraging appointment with Dr Talpaz.

Melanie


Dx - 05/2011; PCR: 15.04; Fish: 87% Slow responder due to pancytopenia. Current - Bosulif - Nov: 2012, Mar 2016 lowered to 300 mg. 07/16 back to 400 mg. Clinical trial drug, Promacta, Feb 2013, for low Platelets.
CyCR - Aug 2014, Positive for 1 chromosome Sep 2015. PCR: 12.77 in Oct, 2012 to 0.04 (MDA) in Mar, 2016. 4/2016 - 0.126 (Local lab (IS); 05/2016 - 0.195 (local); 6/2016 - 0.07 (MDA); 7/2016 - 0.03 (local) 9/13/2016 - 0.16 (MDA); 9/26/2016 - 0.31 (MDA); 11/2016 - 0.012 (local); 01/2017 - 0.24 (MDA); 04/2017 - 0.09 (MDA); Cytogenetics show der(1:7)(q10;p10)7 chromosome mutation. Repeat of Sep 2015. PCR - 6/2017- 0.035 (local); 10/2017- 0.02 (MDA)




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