7 replies to this topic

[scuba]

I received my lab reports today and it was interesting to learn that 65% of my cells were Trisomy 8 (three copies of chromosome 8).

The Monosomy 7 which I had in my last bone marrow was gone (which is good news at least) - and bcr-abl FISH was not done since my PCR is borderline detection.

The Trisomy 8 is a puzzle and it is believed that Dasatinib (Sprycel) can cause it. Interestingly, the presence of Trisomy 8 may make Spyrcel more effective at treating the underlying CML hence why I may be responding so well to low dose Sprycel:

http://moffitt.org/h...i-mds-dasatinib

"Of particular interest is that the Lyn kinase gene is encoded on the long arm of chromosome 8," explained Komrokji. "The gene duplication may augment kinase response capacity and proliferation. What looks like preferential activity of dasatinib in patients with trisomy 8 could be due to the suppression of Lyn, a kinase that appears to aid in proliferation of the disease."

Regardless, I think I understand why I still have relatively low counts (anemia) despite having near complete remission... most of my cells are Trisomy 8. And why such a low dose of Sprycel seems to be effective for me (Curcumin notwithstanding).

I was told that the Trisomy 8 is not a concern, but bears watching (i.e. translate: more bone marrow tests are in my future!). I am bartering to stop Sprycel and test that Trisomy 8 goes away. We'll see if I can be my own trial on that.

Trey: if you would like to see the lab report PM me. I'd be happy to send it to you. M.D. Anderson is very complete in their descriptions of the slides, karotyping, etc. It was a fascinating read.

Michael

[scuba]

Hey ... anyone out there with Trisomy 8? Just curious if you do have Trisomy 8 and it is associated with lower than normal blood counts even though CML is in remission.

My blood counts are still suppressed, although close enough to normal to not affect me - and yet my CML is barely detectable (MMR). I thought by now my cell counts would normalize.

I suspect the Trisomy 8 (that I am told is "common" with TKI treatment) is causing this.

Thanks ...

[simone4]

Scuba, I do not have Trisomy 8, but have had low counts like you for five years.

They never get better.  I am on 300mg Gleevec because of this. 

I am sorry to see you have this extra thing to think about but there

are some who have it and are doing o.k. Have you searched on our board

"Trisomy 8" in the upper right corner.  There are a couple of posts there

and Trey's response plus a citation. 

Did Dr. Cortes tell you that the 65% cells are leukemic, or non-leukemic?

That seems to be the important issue.

Good luck. You seem to be in capable hands. 

Simone

[scuba]

I do not have any Leukemic cells that are observable by FISH, my PCR is too low for them to show up.

I am in MMR and have been for some time now.

Dr. Cortes advises that we'll watch the bone marrow more closely (I'll probably have to have more frequent bone marrow work #_)(@&!(*&), but otherwise my protocol stays the same. I am likely to have this condition

for as long as I have to take a TKI. They don't know if Trisomy 8 is significant or not. My own feeling is that it has a suppressive effect on blood formation.

Not serious enough to try and do anything about it.

My issue is that Trisomy 8 is going up instead of down in the Ph- cells. From what I read, Trisomy 8 aberration usually goes down over time. And most don't have 65%!

For whatever reason, my Trisomy 8 population is expanding. It tells me that my bone marrow is far from healthy even though I feel fine.

[Melanie]

Hi Scuba,

Yes, I've had trisomy 8.  Back in April 2013, my BM showed 2PH+ and 1 trisomy 8. Then in Aug, it went to 3PH+ and 3 Trisomy 8. By Nov, it showed 2 PH+ and no trisomy 8, but due to enhanced banding they now detected del(3q), which was missed on the previous BM. I'm now awaiting results from my March BMB.  Dr Cortes advised in the beginning that the trisomy 8 shows up in about 10-15% of patients on TKI's and sometimes went away on their own and that's what mine did.  The deletion is an unknown factor.  Although my CML is not in remission, it is stabilizing.

My blood counts continue to be below normal, but we manipulate them to stay out of the danger zone with a clinical trial of Promacta for my platelets. I'm at full dosage of what the trial allows and it keeps my platelets between 80-100.  I take Neupogen shots for the ANC, but I'm down to just one a week and it maintains my ANC at around 0.8. The Promacta drug has also had a positive effect on my HBG and it is usually around 10 and I've haven't had to have a transfusion since I've been on it.    All this and I'm almost up to full dosage of my TKI, Bosulif (400mg).  I'm a happy girl!

Hope this helps you in your research.  Take care and pray that your trisomy 8 goes away on your next BM check.

Melanie

[acb]

Dumb question ... can you only tell whether you have Trisomy 8 with a BMB or can you tell from PB? I've only had one BMB. I've been on Sprycel since July 2010 (and was a very quick responder), but I've never had issues with my blood counts (other than low platelets at the 3-week mark but after a week drug break, no trouble since then).

I really want to lower my dose again, but I can't talk my oncologist into it (started on 100 mg 7/2010, was PCRU by 10/2010 and have never had a blip with 3 different doctors and 3 different labs, finally convinced doctor to lower dose to 70 mg in 7/2012 and have stayed PCRU). Just wondering if a higher Sprycel dosage impacts the risk of Trisomy 8 or if there is no correlation.

Thanks!

[jjg]

@ Melanie,

Fantastic news that you are doing well now despite some very hard to budge low counts.

[scuba]

It is believed that TKI's in about 10-15% of CML patients cause Trisomy 8. Why - ? they don't know. Trisomy 8 cells are detected in the bone marrow. It is the higher order cells they are looking at. It does seem that more Trisomy 8 leads to fewer functioning cells in the peripheral blood, hence low blood counts. I am at or near PCRU, but suffer low counts. Not low enough to be a concern, just not normal. I believe it is the Trisomy 8 which is the culprit.

Trisomy 8, in my case, went up between bone marrows. Is it the higher 40mg dose that did it? I don't know. I am now going back to the lower dose in an attempt to see if Trisomy 8 will lower. My PCR doesn't seem to make a difference whether I take 20mg or 40mg. I think about stopping Sprycel altogether and monitor both Trisomy 8 and PCR to see if my bone marrow stabilizes. However - Dr. Cortes was very blunt with me. He said, 'I am more fearful of CML than Trisomy 8'. So Trey's thoughts that one keeps hitting the disease relentlessly has merit. It's a question of risk that one wants to take.

If I had your profile (quick PCRU - deep and consistent), I would very strongly consider lowering dose and monitoring PCR closely. Sprycel can be very effective at low dose and may very well keep you at PCRU. You can always increase dose later.