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#1 CallMeLucky

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Posted 03 June 2013 - 09:31 AM

Really second guessing myself and hoping I haven't made a big mistake.  Saw Dr this morning and had another blood draw for PCR.  Last two PCR (over 2 months) have increased from undetectable, increase hasn't been huge, (.036% and .046%) but those numbers are not IS so hard to tell what they mean.  Basically they said the first result was around -4 log IS and the second one was closer to -3 log IS, which if accurate means I had a 1 log increase over 4 weeks.  We are sending blood to another lab that is IS to get an accurate idea of where I am.  I got the sense Dr was not thrilled with the results so far.  I asked what if it goes up more and he said we should wait to see what results are but basically he would want to do a BMB and see if anything has changed with the disease.  He says it is not common but it does happen where people are doing fine and then suddenly they are not doing fine.  I asked if it was result of low dosage (50mg) Sprycel.  He said it's possible that it is just not enough drug and things are creeping up, but it seemed like he didn't really think that was the case.  I think he thought like I did, that 50mg should have worked well enough on me.  He said in cases where the disease mutates, it wouldn't be because we lowered the dose he's saying the lower dose may cause it to show up sooner. 

I can't help but think I got myself into trouble here.  I was doing fine on Gleevec, I was CMR and I probably should have left well enough alone.  I felt like crap but my disease was under control.  Now I pushed my luck and switched to Sprycel and when I started having trouble with Sprycel I pushed to lower dosage thinking it would be fine.  Now my numbers are going up.  I can't help but think if I had just stayed on Gleevec I wouldn't be in this situation now.  Granted I had trouble even getting out of bed, but now I wonder if I should have just sucked it up.

Now I wait to see how bad this is and where this is going.  Best case I am still MMR and I increase Sprycel and get it back under control, and try to tolerate the side effects.  Worst case....I don't even want to think about, but can't help it.  I really thought I was passed this part and now I am feeling really naive.

I was lucky enough to have this under control and I had to start playing around to try and feel like a "healthy person".  Wake up call, I'm not healthy......


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#2 LLawrence

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Posted 03 June 2013 - 11:19 AM

OK, although I understand the urge to beat yourself up, just stop.  Any person on the planet who was told they have to take a medicine (potentially) forever would try for better quality of life.  Barely getting out of bed just doesn't cut it.

If, worst case you have a mutation, that could have developed on Gleevec as well. You just would have felt worse the whole time you were taking it.

My prayers are for the best case for you.

Leesa



#3 Marnie

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Posted 03 June 2013 - 11:37 AM

Hey, Lucky. . .

Take a deep breath and relax for a bit (I know. .. easier said than done).  It's probably just a little bump in the road.  Think of the water analogy.  Your leukemic cells were just barely under the water level where they were not detected.  Now they've bumped up a micrometer to just above the water level where they show up in the PCR.  Not a significant increase, but enough to show up and scare the bejezeesus out of you.   

I was there a year or so ago, just after I started Sprycel.  I went PCRu and then at the next check, it showed up.  The next time, back to undetectible.  If nothing else, you can probably increase your Sprycel dosage back to 100 mg, if you felt o.k. on that. 

Don't let your mind go where it doesn't need to go.  You will deal with things as you need to, and worrying about what MIGHT be doesn't do anything except add stress. 

Good luck,

Marnie



#4 LivingWellWithCML

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Posted 03 June 2013 - 07:43 PM

Try not to second guess yourself, although I know it's tough.  I would've made the same decision in your shoes, because quality of life has to be a priority!  CML or not, life is still short for everyone - and we can't be miserable with debilitating side effects when we have options.  Also, my wife has to remind me that I AM healthy .... The TKI keeps our health.  Sprycel was a good decision, IMO.  I am expecting that a dosage increase will do the trick, but also note that a stable MMR is also "good enough" to keep our health and live life, so if you can maintain a 0.06% on half the dose and manageable side effects, then that would be a good place to be.


Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg


#5 Trey

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Posted 03 June 2013 - 08:25 PM

Test driving alternative TKIs is not a mistake.  Sticking with one that does not work at a tolerable dosage would be the mistake.  Maybe you are there, and maybe you aren't.  How "Lucky" do you feel?



#6 CallMeLucky

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Posted 03 June 2013 - 10:13 PM

I think that is a good point, I probably should have quit Sprycel early on given my reaction to it.  But I got it in my head that low dose would be fine, always thinking in e back of my head that I would just ween myself off and hold cmr.  I hope this winds up being a good lesson and nothing more.


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#7 scuba

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Posted 04 June 2013 - 10:51 AM

Gary,

I agree with Trey on this one. Quality of life is important and you needed to find out what can work. You should let the 50mg work a bit longer (another month) to see if you stabilize or better still - return to PCRU. If you jump another log, then you need a mutation test and perhaps switch drugs. I would not go back to Gleevec since it caused you so many issues.

I have been on 20mg. Sprycel and am hovering around PCRU - but I also take 8 grams of Curcumin a day. I have a PCR test next week which will tell me if I am on the right track. I have decided to increase my dose to 40mg if my PCR is unchanged or even has gone up. Keep in mind that a one log swing one way or the other is within the error range of the test. I know its tough going from PCRU to detectable - but the good news is this disease is "manageable". You have a choice of the other drugs in case resistance is developing.

Hang in there and let us know your next steps. We're with you on this one.

Michael


Diagnosed 11 May 2011 (100% FiSH, 155% PCR)

with b2a2 BCR-ABL fusion transcript coding for the 210kDa BCR-ABL protein

 

Sprycel: 20 mg per day - taken at lights out with Quercetin and/or Magnesium Taurate

6-8 grams Curcumin C3 complex.

 

2015 PCR: < 0.01% (M.D. Anderson scale)

2016 PCR: < 0.01% (M.D. Anderson scale) 

March        2017 PCR:     0.01% (M.D. Anderson scale)

June          2017 PCR:     "undetected"

September 2017 PCR:     "undetected"


#8 Cathy

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Posted 05 June 2013 - 07:33 AM

Lucky,

I am in the same place as you are about 6 months ago my PCR were sliding upwards. I have been on 50 mg Sprycel for over a year doing very well and did get to PCRU and lost it 3 weeks later haven't got back there but the labs were just inching upward. Finally it went up enough for concern and my onc recommended a second option so I went to Taussig Cancer Center for second opinion. And after allot of money he just said increase dosage and see where we are. BMB didn't show me excelling into another stage as what they were worried about. Next week I'll have my PCR and another mutation test . My doctor had sent one to our reg lab and they ruined the sample . Cancer center was going to do one when they found out my lab messed it up but then didn't have enough left from BMB so he didn't do it. My doctor still wants one done we still don't know why the numbers are going up!  So next week I'll be waiting for results. They put me on 70 mg Sprycel now. I don't seem to feel much different I'm always tired is all. I image this will do the trick. On 100 mg my blood gets too low so that is why we are trying 70 mg.

Try not to worry we have tons of options.

take care!

Cathy


Cathy

 

DX 5-2010  Started normal hydra then Gleevec for 9 months stopped working

Tasigna after 5 pills pancreatis  numbers jumped up quickly

Started Sprycel 100, 8-2010  for a 3 years went down to 50 mg numbers at one point really jumped up quickly

currently on 70 mg for last 2-3 years trying to get onc to reduce dose Numbers never stabilize never MMR till 4-2017 bearly and jump up and down in and out of MMR stayed MMR for 3 months then

After 6 years on sprycel fluid on both lungs, drained still have some fluid on lungs, and currently off drug 4 months now

numbers lower then ever go figure I've never been this low of a number 

last 2 tests .0686 and .0181 !!

 


#9 Pin

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Posted 07 June 2013 - 06:34 AM

Lucky, I really feel for you being in this position. It's hard enough dealing with all of this stuff, the testing, the uncertainty, the fear, waiting for results, all of it - but when we find a way to make something our fault, well then we are really in trouble. I have been trying for almost a year to convince myself that I did not cause my drug to 'stop working', or let resistance, mutations, or whatever else in to increase my results. I am not doing a great job.

I have to say that this about what you said - "He said in cases where the disease mutates, it wouldn't be because we lowered the dose he's saying the lower dose may cause it to show up sooner" - this makes me feel like maybe it is not my fault. My doctor told me that it's possible that the herbal medications I took could have "allowed some resistance to creep in". It is difficult when someone offers an opinion which supports your fears. I really feel sometimes that I am stuck between trying to convince myself everything is fine and that my results aren't even bad, they're still below 0.1% etc. etc. and my doctor, who like yours, feels something may not be quite right. So I am on monthly testing, I've had 2 mutation tests now, and 2 Imatinib plasma trough tests. I haven't received the second lot of these yet...no news is good news, right? I am due for my next test in a couple of weeks, so we will see where I am at then. I am still hopeful this is much ado about nothing.

I can't help but feel that in your case it looks like a case of 'not enough drug' - and perhaps that is the same for me. Your case is complicated by the change in lab as well though of course. Sometimes I wish I could stop worrying about the tiny little numbers and remember that they are not as accurate as we think, it is not the same as actually counting something that is physically there - the meat axe analogy.

I hope you are feeling ok about all this, it can be so difficult some days. I have had one of those days where I am aching everywhere, and everything feels like disease progression. Those days are hard.

Anyway - Enough rambling from me!


Diagnosed 9 June 2011, Glivec 400mg June 2011-July 2017, Tasigna 600mg July 2017-present (switched due to intolerable side effects, and desire for future cessation attempt).

Commenced monthly testing when MR4.0 lost during 2012.

 

2017: <0.01, <0.01, 0.005 (200mg Glivec, Adelaide) <0.01, 0.001 (new test sensitivity)

2016: <0.01, <0.01, PCRU, 0.002 (Adelaide)

2015: <0.01, <0.01, <0.01, 0.013

2014: PCRU, <0.01, <0.01, <0.01, <0.01

2013: 0.01, 0.014, 0.016, 0.026, 0.041, <0.01, <0.01 

2012: <0.01, <0.01, 0.013, 0.032, 0.021

2011: 38.00, 12.00, 0.14


#10 CallMeLucky

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Posted 07 June 2013 - 08:47 AM

I can so relate to the having a bad day where every ache feels like "disease progression".  I have been feeling flush, almost feverish, but I have no fever.  I have an infected Lymph node in my neck that I get from time to time, but this time I feel like it is suddenly related.  I have pressure in my chest that pretty much amounts to really bad heartburn.  Can you say stressed out?  Amazing what our minds can do to our bodies.  Add to that I am on a 30 day course of antibiotics for my pelvic pain problem.

I have another crazy theory too, the last month my side effects haven't bothered me much, I just started a new bottle of Sprycel and I feel like a brick hit me.  Sometimes I wonder what if I got a bad batch of Sprycel, expired, mixed incorrectly, or even counterfeit how would you even know?  I know that is highly unlikely, but just one of the crazy places my brain goes.  Trying to keep level headed, the reality is that I am just not cut out for this type of lifestyle, I worry too much it is my nature and now I have something serious to worry about, makes it hard and sucks the enjoyment out of everything.  But this is my lot in life, perhaps in a bigger way I have to go through this for some reason.  I'm waiting to hear from Dr he said he would have results by end of week, but I'm betting he won't have them until next week.  Everytime I see a voicemail I get nausaues. 

I am sorry that you seem to be in a similar situation, the reality is we will probably both be fine.  We want to get to a place where the disease appears to be gone and then go on cruise control, but for most that is not how it goes.  We have good periods and bad I guess.  I hope your days get better and you get some good news soon.  For what its worth, there doesn't seem to be any data to support the idea that an herbal supplement would cause your disease to mutate and become resistant to treatment.  I suppose we could always say "you never know" but at the end of the day, while I could see an herbal med possibly interfering with Gleevec, once it is removed you would expect things to work the same way.  If they aren't then most likely they weren't going to anyway.  So no point beating ourselves up over something we'll never know.  Almost like beating ourselves up for getting CML in the first place - "if only I ate more vegetables"


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#11 CallMeLucky

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Posted 07 June 2013 - 04:35 PM

Well I got my PCR results back.  .0236% IS.  A little less than a 4 log reduction.  So I lost my PCRu but so far I haven't lost my MMR.  Dr says he wants to do a mutation analysis.  I questioned if it was necessary and he said it is unlikely it is a mutation, but he doesn't want to miss it if it is.  He says it is probably that 50mg of Sprycel is not enough (but while he didn't say it I could tell that he thinks 50mg should have been enough for me to hold PCR negative).  So I am going back up to 70mg immediately and will see where this goes.  I go in for test on Wed, not looking forward to another BMA, but I wanted to be adventurous so I guess I should have been prepared for it to blow up in my face.  Hopefully it comes back clean and if not, hopefully not T315i.  I'll work my way back up to 100mg and see if I can tolerate it, if not I go to another drug.

I hate the unanswered question hanging over my head, but I guess this is the best way to go so I know for certain.  I questioned what if I just went back up in dose and see if it goes negative again, he said he suspected it would, but he kept going back to the what if, not scaring me, he was joking around with me most of the time, but he just kept saying, what if there is something there, we don't want to miss it.

the crazy thing is for most people this is a great result, his concern is that I got to PCRu quickly and held it for around a year and now I am not PCRu.  Yes it coincides with the reduction in dose, but what if?  I hate the what if.......


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#12 LivingWellWithCML

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Posted 07 June 2013 - 05:25 PM

Lucky, aren't all of these recent tests within the margin of error -- essentially saying that you're a stable comfortable MMR+ on reduced-dosage Sprycel when it's all said and done?  I understand that it's not PCRu and that you held that level of response for a year, but we know that PCR is a wacky test and CML disease burden can actually fluctuate around intangibles like stress, etc.  Gosh, it doesn't seem like there's any trend here that would indicate either a mutation or a loss of response, right?

It is interesting to compare docs' philosophies -- maybe my doc is too conservative about the whole thing, but I went to PCRu within 12 months on Gleevec 400mg, but then in year two I became detectable again and went from 0.04% to 0.124% to 0.125% and back down to 0.082%.  The whole time he said 'stay the course' and didn't recommend BMB/A or dosage change or TKI change - I totally stressed over it, which probably made my PCR go up in the first place!  He just said that I'm CCyR and stable MMR, and that's the prognostic indicator.  My understanding is that a mutation would cause one's PCR to rise pretty steadily from test to test ... that doesn't appear to be the case for you.

We're with you on this journey, my friend ...


Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg


#13 CallMeLucky

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Posted 07 June 2013 - 07:27 PM

Dan,  I think if I was still on Gleevec, and more importantly still with the same Dr, I might get the same advice you are getting, my Dr probably would have said stay the course.  In my case I switched Dr and pushed to go on low dose (a failed experiment to some degree).  I think the Dr is going extreme, but I kind of understand why, he wasn't crazy about the low dose option but agreed to it and now things went sideways.  I think he is looking to be prudent to make sure he doesn't miss anything.  I'm not happy about it, and I think everything you said is accurate and actually makes me feel better reading it.  At the same time, his point made sense "why go on months worrying about this?  If we increase dose or switch drugs and your PCR doesn't go negative we are going to continue to ask the question if a mutation is there, so let's just get it off the table and get back to focusing on finding the best drug that works and provides a good quality of life."  When he put it that way it was hard to argue with.  Yes the BMB sucks and waiting for the test results will be hard, but if it comes back clean then I can stop worrying about it, and if it doesn't then we can narrow down which drug would be best.  If I have a mutation that Sprycel is not so good against then going to Tasigna would be a no brainer.  If no mutation then maybe I just need a little more Sprycel and can continue.  The interesting thing here too is that it is possible my PCR would stay where it is at this dose.  Many Dr would say that is fine.  My Dr has no problem with where my PCR is today, he has some concern about the change from negative to positive.  Probably the dosage, but wants to rule out anything else.  I got myself into this, I opened Pandora's box and now I have to see it through.....

Thanks for the support......


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#14 Pin

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Posted 07 June 2013 - 07:37 PM

Glad to hear that Lucky, especially that you got them before the weekend - it sounds like our doctors both went to the same school! Mine is doing all the checking just to rule things out I guess, because I had a similar level of response (<4.0 log) and then lost it, in the meantime it is a bit stressful for us. I don't think they believe that mine is a mutation either, it's possible that it is one of those ones that gleevec can just 'get around' a bit, but doesn't cause a loss of response (fingers crossed, I am the most anxious about my next test as at the last one I was convinced it was going to go back down and instead it went up). Whilst I am very appreciative of the checking, covering all bases, and not wanting to miss things - it is also good to get other doctors' opinions, like Dan's doctor - that shows that in most cases, these levels of response are perfectly fine, long term too, not just for now. Sometimes it helps me to remember that being undetectable does not (as yet, as far as we know) offer any further protection, other than the obvious one of allowing us to 'cruise' a bit ;) and of course  perhaps eventually allowing us to trial medication cessation. I think you will knock yours off with the increase in dose. Also, just a thought but I think I will try to only add two decimal places after the decimal, and add a zero before it - 0.04% sounds much better than .041%, don't you think? ;)


Diagnosed 9 June 2011, Glivec 400mg June 2011-July 2017, Tasigna 600mg July 2017-present (switched due to intolerable side effects, and desire for future cessation attempt).

Commenced monthly testing when MR4.0 lost during 2012.

 

2017: <0.01, <0.01, 0.005 (200mg Glivec, Adelaide) <0.01, 0.001 (new test sensitivity)

2016: <0.01, <0.01, PCRU, 0.002 (Adelaide)

2015: <0.01, <0.01, <0.01, 0.013

2014: PCRU, <0.01, <0.01, <0.01, <0.01

2013: 0.01, 0.014, 0.016, 0.026, 0.041, <0.01, <0.01 

2012: <0.01, <0.01, 0.013, 0.032, 0.021

2011: 38.00, 12.00, 0.14


#15 Susan61

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Posted 07 June 2013 - 08:58 PM

Hi Lucky:  Been reading all your ups and downs here.  Would you consider trying the Gleevec again, and maybe it would not wipe you out like it did the last time.  Now that your body has been on TKI drugs, maybe you would have a different response.  I really am not up on all of it, just a thought.

     I think our doctors play around with things also, as they are not sure what the right way is to go.

    Wishing you the best on your results.

Susan



#16 CallMeLucky

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Posted 07 June 2013 - 10:18 PM

I have been giving serious thought to going back to Gleevec.  It is such a challenge I know I felt crappy on Gleevec but I felt safe for the most part, no chest pain or intense stuff just a general feeling of malaise and achy muscles and bones.  Not a great way to live but in many ways it was less challenging.  Right now I'm wishing I tried Tasigna but that's kind of dumb because if I had a problem with Tasigna we would have done the same thing and been saying "wish I tried Sprycel instead".  I think switching from Gleevec made sense, where I screwed up was pushing the low dose option.  When it became clear that Sprycel didn't agree with me I should have just moved on.  I didn't want to lose it as an option and I thought I could get away with it.  So now I'll do the mutation test, pray it comes back clean and then probably move on to something else and yes going back to Geevec will probably be considered but probably not picked, I doubt I would react any different to it the only thing that would be different is my willingness to deal with the discomfort based on this experience. I'd still like to find something that gives me a good response without feeling so unwell.


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#17 scuba

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Posted 08 June 2013 - 09:12 AM

Gary -

I read this whole episode you are going through quite differently. You made a switch in drugs which included complete drug cessation. I believe it was the drug cessation which is the culprit here. It takes time - months for the body to re-react to the renewed TKI pressure. I think staying the course and giving yourself two - three test periods (nine months) to see if there is a trend is a good way to go. You are still MMR+. Your PCR reading is only slightly above PCRU. And - most importannt - you feel fine at this dose in comparison to Gleevec. I would never go back to Gleevec - there are too many newer more potent drugs with better side affects profiles to try first.

The CML was given a chance to re-assert itself with the drug stoppage. There is a great chance that you will get back to below detection again with the course you were on.

A mutation test is fine for peace of mind, but I was told that when a mutation takes over, PCR jumps quickly with orders of magnitude increase and that you would see a FISH response. Dr. Cortes mentioned that FISH usually will show positive when PCR goes above 1%.


Diagnosed 11 May 2011 (100% FiSH, 155% PCR)

with b2a2 BCR-ABL fusion transcript coding for the 210kDa BCR-ABL protein

 

Sprycel: 20 mg per day - taken at lights out with Quercetin and/or Magnesium Taurate

6-8 grams Curcumin C3 complex.

 

2015 PCR: < 0.01% (M.D. Anderson scale)

2016 PCR: < 0.01% (M.D. Anderson scale) 

March        2017 PCR:     0.01% (M.D. Anderson scale)

June          2017 PCR:     "undetected"

September 2017 PCR:     "undetected"


#18 CallMeLucky

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Posted 08 June 2013 - 08:57 PM

I don't know if this could be tied to the cessation but maybe. I took a two week break back in Nov and then went on Sprycel at 100 mg.  I took another break in Jan for one week, then after the last visit to ER I stopped on my own for a couple of days until I saw new doctor who agreed to lower dosage.  I went 50 then 60 then 70 for a month each then dropped back to 50 and the next PCR became detectable.  So there was inconsistency and maybe enough to allow it to come up.  Also during the time I was on 50 and 60 mg I was also on Protonix.  If Protonix was blocking some of the Sprycel then that is a contributing factor as well.  I'm thinking that the most reasonable explanation is that I was not getting enough drug and that is letting it creep up.  The fact is Sprycel hasn't been a great drug for me even at 50mg I am having some pulmonary issues.  I considered them tolerable and figured it was better than trying another drug.  My last dr made a statement about only being 40 and do I really want to burn through all my options.  Of course that logic doesn't make a ton of sense because if it doesn't work for me today it's not going to work for me in the future.  Still I figured I should try to tough it out always telling myself its not so bad, I did that with Gleevec for a while.

I know I won't be able to do 100 Sprycel and after this situation I'm not so keen on the low dose approach.  Assuming no mutation comes back I will likely be switching to something else.  I don't see going back to Gleevec at this point.  I think Trey was correct that there is nothing wrong with trying other drugs to see if they can make your QOL better, where I messed up was playing around with the dosage.  Lowering dosage for blood counts or a PE is justifiable, lowering for QOL is risky and now I have to work through the mess I made.  I am hopeful this just comes down to not enough drug and they won't find any mutations and I can move on to either Tasigna or Bosulif.  It'll be a tough two weeks but I'll get through it.

Thanks for all the comments and support.


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#19 nathaliece

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Posted 09 June 2013 - 06:04 PM

Lucky, I am sorry you are going through this but encourage you to try other TKI options.  I had a good response to Gleevec but the side effects were rough and since my oncology team did not agree with a dosage reduction, I switched to Tasigna.  The side effects have been easier for me to tolerate. 

Sending you good wishes for a better solution that works for you,

Nat



#20 CallMeLucky

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Posted 09 June 2013 - 06:33 PM

Thank you, I don't think I am going to have much of a choice when it comes to switching.  I just went up to 70mg two days ago.  I have a painful swollen lymph node in my neck, I have a rash and hives all over my body and I am running a low grade temp about 100.    The bottom of my feet itch I want to smash something!  Just took one Benadryl, one Advil and put on some topical caladryl lotion.  I'll get my BMB and then move on to something else.  I just have to find the set of side effects I can live with.  The reality is if Sprycel just gave me this rash I could tolerate that.  Ok, done complaining.....
Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 





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