- Given everything we know now re: CCyR + MMR, the benefit of deeper log reductions, and CMR in long-term prognosis and potential remission, how important is it that one focus on reaching deeper molecular response levels into the 3rd year+ of treatment? Given my tolerance to 400mg, does 600mg sound like the appropriate option that I should be seriously considering at this stage? I don't think I need to consider a TKI transition given that I've tolerated and responded well to Gleevec up to this point.
- When weighing choice of hematologist, how important do you all consider on-site PCR testing in your decision-making process? I'm aware of the blood sample degredation introduced by off-site PCR testing, so I've been really comfortable at Emory because they do all of their testing on-site, and it's a short drive from my home - I don't want to take the convenience and the quality of testing for granted. But if a dosage increase needs to be seriously considered, then I will also need to look at testing methods when evaluating other hematologists - it would impact my options. Any thoughts here?
- Is staying on 400mg a reasonable course and low risk given that I'm essentially right at the MMR point heading into year three? I look and feel healthy and have been able to maintain an aggressive athletic lifestyle despite taking a daily TKI, so I don't necessarily want to risk a decrease in quality of life that a dosage increase might introduce - especially if it's really not needed.
- On that front, I exercise a LOT ... I've always felt that it has helped me on my journey, but is it possible that my flat PCRs could be a result of extensive athletic activity (which I'm sure puts my bone marrow under regular stress to pump out RBCs)?
- I'm not aware of Emory doing plasma concentration testing, but I wonder if there are things I can control to try and safely increase the absorption level of Gleevec in the bloodstream. Acidic environments have been mentioned -- should I consider taking a Vitamin C supplement at the same time, or something else to help? I take the dose with breakfast, which sometimes includes a very small amount of 2% milk in cereal (I mean, literally just a small splash in the bowl), but maybe I should consider drinking watered-down OJ or something else to increase the acidity in the stomach? Other ideas?