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Intro after 2 1/2 years of lurking

New side-effects dasatinib history trey work

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#1 Leuk Skywalker

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Posted 04 August 2015 - 12:03 AM

Hi LLS CML people,

 

Just a quick note to introduce myself after a couple of years of lurking on this forum off and on. I am a man in my mid-thirties. I have had CML for 2 and a half years now. Currently PCRU, have been for the last year. On dasatanib as I had additional mutations (trisomy 8 and an additional BCR-ABL). In my country I think the standard approach is to start on Gleivic: based on what I read about side-effects I am very grateful that my excellent haematologist put me straight on dasatinib.

 

When I was diagnosed I was seriously ill for about 2 months including a 4 day stay in hospital, having possibly got some fever or infection that my body couldn't deal with. Went from initial phone call from GP to hospital ER next morning, bone marrow biopsy by lunch, straight on the hydroxy-urea and formally diagnosed within a couple of weeks. This rapid journey was made more harrowing by my partner's initial Google searches which included some out-of-date material and led us to suspect blast-crisis phase and thus dramatically worse outcomes. When she found LLS and particularly Trey's stuff it really helped make sense of very complex test results and to go from extreme worry to a more realistic place. One of the reasons I am writing is just to thank Trey for his work, it is much appreciated!

 

When I was diagnosed  I chose to let her read the studies and browse the web while I just waited for the pills to either work or not work... to some extent I am like that still, I am religious about taking my meds but other than taking vitamin C at the same time and avoiding things that might mess them up (grapefruit or whatever) I am fairly passive/ fatalistic. I mainly enjoy reading forums to share other peoples issues with TKI side-effects and how they cope with the psychological aspects of having cancer.

 

I recently completed my post graduate qualification, a very tricky task while undergoing treatment: main challenges were tiredness, low mood and "energy", poor quality sleep and "brain fog" plus a period of horrendous mouth ulcers early on.  My bloods are now pretty good, with all markers, liver function etc. in normal ranges. Am now working full-time but often find myself tired and struggling to maintain concentration on complex topics. My long term hope is to successfully go off the meds after say 5 years PCRU. Might even try going off sooner but my partner tells me that odds of staying off are increased for people who have been on TKIs longer so that has to be weighed up.

 

Naturally I am very grateful to be living in this age and to have a type of cancer which for which targeted "cures" are possible, I am well aware that I would be long dead or destroyed by a bone marrow transplant if this had happened 20 years ago. However, now that smoke has cleared from study and severe illness I am doing the frustrating work of trying to figure out if I can handle working full-time long term, learning to say no to things and to prioritise, and making decisions about things like having kids. I do not socialise with other leukaemia sufferers (there is one similar person in my neck of the woods but after an initial contact I decided that we didn't have much in common - I suspect he felt the same too) so sometimes I feel a little isolated, have many friends but sometimes it feels like a bit of a "bummer" to be complaining about invisible symptoms... I am also aware that many symptoms could have other causes (like getting older!)

 

Things I have picked up from the forums include taking magnesium for brain fog plus focusing on getting sleep/rest. I am also trying to get seen by a shrink to maybe see if some type of ADHD med might help (never had anything like this before).

 

Probably obvious from my spelling but I am not American, my sympathies for all the dramas and additional challenges that American CML sufferers have to go through with co-payments/Medicare/insurance etc. Sounds horrendous. 

 

Have gained a lot from being a lurker and from my partners lurking on this forum so thanks LLS CML peeps and Trey in particular! 

 

Leuk



#2 ChrisC

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Posted 04 August 2015 - 02:12 AM

Hi Leuk,

 

Welcome! So glad that you have spoken up and joined the discussions.

 

You sound, to me, to have your head on straight! Much appreciation to your partner, too, for her contributions to your well being, and in your journey together.

 

Here, you are one of us. No separation due to language or nationality: just part of our unique, special, comprehensive group!

 

Best of luck on your future decisions, your prognosis, and your joy in living.

 

All the very best,

 

ChrisC

 


Be alert, but not overly concerned.

 

• Dx Oct. 22, 2008, WBC 459k, in ICU for 2 days + in hospital 1 week

• Leukapheresis for 1 week, to reduce WBC (wasn't given Hydroxyurea)

• Oct. 28, 2008: CML confirmed, start Gleevec 400mg

• Oct. 31, 2008: sent home when WBC reached 121k

• On/off, reduced dose Gleevec for 7 months

• April 2009: Started Sprycel 100mg

• Sept. 2009: PCRU 0.000

• Sept. 2011: after 2 years steady PCRU & taking Sprycel 100mg before bed, quit Sprycel (with permission)

• Currently: still steady PCRU, testing every 6 months 🤗

— Fatigue, hearing loss continue, alas, but I prefer to think it is all getting better!

 

 


#3 alexamay09

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Posted 04 August 2015 - 03:53 AM

Hi Leuk - I am almost 3 years in now, and was thought to be accelerated phase initially.  I I am from the UK and I have found this site an incredible source of advice, information and support.  Just wanted to wave 'hello'!

 

Alex



#4 hannibellemo

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Posted 04 August 2015 - 05:55 AM

Welcome, Leuk,

 

Love the name! Glad to hear things are going, on the whole, good for you and hope that you can get a handle on the little blips in your CML journey.


Pat

 

"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>


#5 AllTheseYears

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Posted 04 August 2015 - 10:35 AM

Leuk:  My CML diagnosis came about 14 years ago....so you can not only survive but thrive. I also was seriously ill when finally diagnosed; then began treatment on the old, pre-oral drugs but switched to Gleevec.  I, too, experienced all the ups and downs, the fears and anxieties you write about.  Truthfully, I still fall into cycles of experiencing the same worries I experienced back at the diagnosis.  I've found ways to plow through them.

 

As to some of the things you mentioned in your post: 1) I continued to work full time for a while after diagnosis, and worked full time when I was in a "positive cycle."  Eventually, I accepted that part-time work was best.  A full-time job meant that all I did was work, then come home and rest on the sofa.  Not good.  2)  About the social isolation. Oh yeah, that's an issue, one I still fight.  It  seemed to take so much effort to be social, when people didn't understand what I was going through, that withdrawing from people seemed preferable. It's not.  Isolation takes a mental toll.  I once told my now ex-husband, "Everyone seems like ants running around on an ant hill to me, scurrying about doing nothing."  He didn't get it. I hope you can fight the feelings of isolation.  I have learned to hang out only with people who "get it" as best they can....who at least aren't scared by or deny my situation.  I'm selfish with friendship. 

 

3) As for all that intimidating information out there, I found that I had to avoid it sometimes.  I researched only when I felt emotionally up to it.  However, being informed is key to getting good treatment and good outcomes; you've got to be your own best advocate.  And I found I had to be knowledgeable in order to ask good questions of my oncologist and gain his respect.

 

Hang in there.  We CML survivors might be blessed with a normal life span, but that's not the same as a normal life.  When I accepted that, I think my outlook improved.  After more than 13 years, I still have to remind myself of that occasionally to dispel my fears and anxieties, and frankly, to let up on myself so that I can enjoy life.  Best to you. - B.J. 



#6 Trey

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Posted 04 August 2015 - 02:26 PM

LS,

Q: What did the originating Philadelphia Chromosome say to its mutant leukemic offspring?

A: Leuks, I am your father.

 

So your translocation was der(22)t(9;22)(q34.1;q11.2) ?

Did you have the P210 (e13a2 or e14a2) type Philadelphia Chromosome?



#7 kat73

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Posted 04 August 2015 - 05:17 PM

AllTheseYears - Great advice, extremely well put.  Trey - Magnificent, truly.  Still chuckling . . .


Dx July 2009 on routine physical.  WBC 94.  Started Gleevec 400 mg Sept 2009.  MMR at 2yrs.  Side effects (malaise, depression/anxiety, fatigue, nausea, periorbital edema) never improved.  Kidney issues developed because of Gleevec.  Switched to Sprycel 70 mg in Aug 2011.  Above side effects disappeared or improved.  Have been MR3.5 - 4.5 ever since.  Two untreated pleural effusions followed by one treated by stopping Sprycel Jan 2017.  After 9 weeks, PCR showed loss of MMR; re-started Sprycel at 50 mg and in 3 months was back to <0.01% IS.  Pleural effusion returned within a couple of months, same as before (moderate, left side only).  Stopped Sprycel 50 mg for 12 weeks; pleural effusion resolved.  At about a monthoff the drug, PCR was 0.03; at 11 weeks it was 2.06 - lost CCyR? Have returned to 50 mg Sprycel for 3 weeks, intending to reduce to 20 mg going forward.


#8 Billie Murawski

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Posted 04 August 2015 - 06:02 PM

so do we call you Trey,Darth, or Sir?

Welcome Leuk, you're definitelty in the right place now for all the correct information. Be prepared for a few laughs, we all have our ups and downs bit we sure don't let them keep us down.      Sincerely Billie



#9 Leuk Skywalker

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Posted 04 August 2015 - 09:11 PM

Thanks for  your replies Chris, Alex, Pat and B.J!

 

I like the idea that a normal lifespan =/= a normal life. I feel like I need that idea at the moment.

 

Trey I need to dig up the paper work... one of the nice things about being PCRU for a year is that my partner was not able to instantly answer your question! I do need to become more informed, I have that book "The Philadelphia Chromosome" sitting on my shelf but I'm still not ready to open it...

 

Billie: I reckon it should be Darth Trey, cos he is on the other side from Leuk... but Darth is evil... not sure.... 



#10 Billie Murawski

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Posted 05 August 2015 - 12:23 AM

Leuk,

  Trey is far from evil but he does tend to be a bit conniving. He likes to catch us off guard with some crazy innuendo, then it takes me four days to figure out what he is talking about. 

 Don't drive yourself nuts about the Philadelphia Chromosome most of us have it. I figure it's some tiny chromosome running around Philadelphia Pa. trying to figure out how the Liberty Bell got a crack in it.

                                                                       Billie



#11 Leuk Skywalker

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Posted 05 August 2015 - 12:41 AM

Hi Trey my partner tells me that it is :

 

48,XY,+8,t(9,22)(q34;q11.2)+der(22) t(9:22) ?<20?>

 

Don't know if the answer to the question about P210 (e13a2 or e14a2) type Philadelphia Chromosome is contained in that bit of mumbo jumbo...

 

Apparently the 20 states that the abnormalities were found in all 20 cells examined...

 

Billie: maybe it is the chromosome that determines ones preference for... cheese steak (?)



#12 Billie Murawski

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Posted 05 August 2015 - 12:52 AM

Cheese Steak oh yeah we must share the same chromosome.



#13 Trey

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Posted 05 August 2015 - 09:09 AM

The +der(22) t(9:22) shows you had a doubled Philadelphia Chromosome, and the [20] shows it was in all 20 white blood cells examined.  You also had trisomy 8 in all white blood cells examined as shown by the +8.  You already know that, just decoding the karyotype.

 

The "48" is unusual to see since humans have 46 chromosomes.  The extra two chromosomes are the extra 8 (trisomy 8) and the extra 22 (second Philadelphia Chromosome).  The 48 is only in the leukemic blood cells.  All other cells in your body always had 46 chromosomes.  Now that you are PCRU you are back to 46 chromosomes in the blood cells (except for any residual low level leukemic ones).  By the way, gorillas, monkeys, tobacco, and plum trees have 48 chromosomes.  Just some karyotype trivia.

 

It is a good thing you had an Onc who stuck with the TKI drugs and it turned out well.  Most Oncs would have pushed you into a transplant.  The ability of the TKI drugs to overcome such variations is amazing. 



#14 Leuk Skywalker

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Posted 05 August 2015 - 08:17 PM

Thanks Trey - the haem/onc didn't let on that it was that serious but he did suss out potential donors (one of my brothers and my sister) pretty quick which is apparently not standard practice... I guess it was a calculated risk to try dasatinib first and I am lucky that it paid off!

 

Complicating the discussion, my partner tells me that the additional mutations that I have are indeed often associated with worse outcomes, but that she did find a paper which really dug into risk factors (based on measures taken at point of diagnosis) that predict likelihood of failure for TKI treatment and it seems that additional mutations often come as part of a package with various other things which are associated with a poorer outcome i.e. percentage of blasts in peripheral blood etc. Seemingly when regressions were carried out and the effects separated, trisomy 8 and additional BCR-ABL were not strongly associated with higher rates of TKI failure when all those other factors were controlled for. I did not have many of these other worrying features. I'm sure you would have read the paper but I'll let you know the name if I can dig it up.  No idea if this type of research influenced the Profs decision making.

 

Re: the exact type of Philadelphia Chromosome, I don't have the answer but I believe it is one of the more common ones.... 
 
I am curious about whether you think my progenitor stem cell would already contain the additional mutations or if they would have happened in some factory cells further down the chain. This seems like it could be relevant to making decisions about going off dasatinib at some point.
 
Thanks for your answers - the info is appreciated.


#15 Billie Murawski

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Posted 06 August 2015 - 02:51 AM

Trey and Leuk.......................................HUH!



#16 Trey

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Posted 06 August 2015 - 03:43 PM

I am curious about whether you think my progenitor stem cell would already contain the additional mutations or if they would have happened in some factory cells further down the chain. This seems like it could be relevant to making decisions about going off dasatinib at some point.

 

There is no way to know for certain.  I assume you only had one BMB?  If any others ever showed the "regular" Philadelphia Chromosome, you would know it happened at a lower level. 

 

The trisomy 8 mutation is normally more likely to occur at a lower level progenitor cell, but since it was in all 20 at diagnosis, the probability is very high that it was there in the originating leukemic cell in your case.



#17 missjoy

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Posted 16 August 2015 - 07:20 PM

Hi Trey,

 

This comment was posted "I am curious about whether you think my progenitor stem cell would already contain the additional mutations or if they would have happened in some factory cells further down the chain. This seems like it could be relevant to making decisions about going off dasatinib at some point."

 

Could you explain to me the significance of where the additional mutation occurs (progenitor cell or lower level) is an important factor and whether this is a consideration in participating trial to stop TKI?

 

By the way, what is a factory cell? Is it a ribosome?

 

Thanks!

 

 



#18 Trey

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Posted 16 August 2015 - 08:32 PM

The way to know that a kinase mutation occurred in a lower level progenitor cell rather than the originating leukemic stem cell is that the mutation would disappear by itself over time.  Depending on the level, the progenitor cell would divide a certain allotted number of times and then die.  But the originating leukemic stem cell presumably has a very long life* since it divides only rarely, so the mutation would remain over the long term. 

 

 

* I say "presumably has a very long life" because there is a theory that in the presence of continuous TKI drug killing off the leukemic offspring the originating leukemic stem cell might need to divide often to keep the CML going.  Under this theory the originating leukemic stem cell could be driven to divide itself into oblivion by TKI drugs, and even though the TKI drugs do not directly kill it, this theory suggests an indirect kill may be possible.  This theory also suggests remaining on TKI drugs over many years may possibly produce a cure, while stopping TKI drugs too early might relieve the pressure on the originating leukemic stem cell and allow it to escape.



#19 Billie Murawski

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Posted 16 August 2015 - 10:33 PM

I got it A TKI stuffs all the leukemic cells in 1 chromosome and doesn't ever let them out!!!!! B)



#20 missjoy

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Posted 20 August 2015 - 01:25 PM

Thank you Trey for being so generous with your time and knowledge!

 

At what level,"adult stem cell, daughter stem cell or myeloid progenitor cell" did the chromosome 9;22 mutation occur? Or, at what level did some stem cells become leukemia stem cells?

 

Thanks!







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