8 replies to this topic

[MJB]

52 months post diagnosis and my latest PCR went from .002 in June  to 3.03 now (non international scale.) Could this be a lab error or what?

IForgot

[August1]

Hi MJB,

It could be an error in translation especially if it's non-international scale as you say in your post. Did anything change with regard to your treatment and has your onc. scheduled a follow up PCR? I might suggest getting another PCR (IS Scale) run.

[Trey]

If it was the same lab, the jump is too much to ignore.  You should have a repeat PCR done right away to confirm the validity of the latest result.  It could be a lab error, or it could be an "or what".

[MJB]

Thank you for the replies! I went back for another PCR and my onc said that the lab has finally switched to International scale PCR. The 3.03 is on the IS but the .002 is the same lab but taken before the switch. I asked if the jump could be due to the change and onc didn't think so stating that low level should have remain low level whether IS or not. We will know the new results in a week. The plan is to remain on current dose if results are the same or better, increase dose if small increase in PCR. She also ran a FISH test. Does all of this seem right. ? My pb are normal except for low rbc. Also I went about 6 weeks without taking my Sprycel so that is probably the reason for the increase. This far into treatment and at such a low disease burden. I really didn't expect such a jump!

[Susan61]

Hi:  I think you just answered your own question regarding skipping your Sprycel for 6 weeks.  Everyone's body handles their TKI drug differently.  Some take a vacation from their TKI if they are having some type of problem.  If your doing good, then stay on a regular schedule with your medication.  You said you were off for 6 weeks, but how long have you been back on your Sprycel before getting your blood work done.?  Did your doctor know that you  missed all those doses?

    Things should level out as long as your back on your Sprycel now.  Good Luck

Susan

[Trey]

The repeat PCR and FISH are good procedure.  Good for your Onc.  The 6 weeks off Sprycel is a long time, so would be the primary suspect.  Also, the change to IS scale can throw results off a lot if it is a small lab or a small town location.  The reason is the lab uses other CML patient's PCRs to develop their internal IS conversion factor.  So the smaller the lab or the more remote the location the more likely the IS will result in greater swings in PCR results.  So the switch to IS could be the entire cause for your uptick, or it may not be.  The repeat results should clarify the issue, and the FISH will show if you remain CCyR.  Anyway, your Onc is doing well for you.

By the way, this should cause those who are anxious to jump into stopping TKI drugs to think very carefully about the issue.  The disease can sometimes come back quickly. 

[GerryL]

Trey's right (as usual) - during the Australian STIM (Stop Taking Imatinib) trials, for those that relapsed the CML came back fast. Restarting their TKI returned most people back to their PCRU status. You need to be carefully monitored (monthly monitoring is used for the first six months) when stopping your TKI in a trial.

[MJB]

The lab is Sloan Kettering so it's quite large but good info to know about the switch to IS.  Kinda scary how quick the PCR can increase.  One more question. I have been bruising really easy! Like bruising if I kneel down!  Could this be related to the cml or is it something else. My blood counts are normal except for slightly low rbc.

Thank you for being here!

[GerryL]

Bruising can occur with the lower RBC.