2 replies to this topic

[OhNanna]

My Onc has never shared any of the blood work numbers with me. I recently saw a thread where Trey explained what some numbers meant. The only number ever shared was the WBC. (was 37 at first test and 53 only 3 wks later. After 30 days on Gleevec it was down to 17. I understand normal is between 4 and 10.) I'll see him again this next week. What information do I need to know? Or am I perhaps better off not caring or knowing? I don't want to doctor myself, but I don't want to be stupid either. I can see all blood work results on a website but can't figure out what they are or how they correlate to numbers that others here talk about.

And what about all the acronyms? PRC, PCRU, BCR-ABL, FISH, MMR
What do I really need to know?

[gerry]

Can you get a copy of your results out of your doc, it will help Trey if you can put the details in.

 

This is from the lls info https://www.lls.org/..._assets/cml.pdf There is a table on page 28 which explains CHR, CCyR, MMR and CMR/PCRU.

 

Diagnosis To diagnose CML, doctors use a variety of tests to analyze the blood and marrow cells. Complete Blood Count (CBC). This test is used to measure the number and types of cells in the blood. People with CML often have { Decreased hemoglobin concentration { Increased white blood cell count, often to very high levels { Possible increase or decrease in the number of platelets depending on the severity of the person's CML. Blood cells are stained (dyed) and examined with a light microscope. These samples show a { Specific pattern of white blood cells { Small proportion of immature cells (leukemic blast cells and promyelocytes) { Larger proportion of maturing and fully matured white blood cells (myelocytes and neutrophils). These blast cells, promyelocytes and myelocytes are normally not present in the blood of healthy individuals.

 

Bone Marrow Aspiration and Biopsy. These tests are used to examine marrow cells to find abnormalities and are generally done at the same time. The sample is usually taken from the patient's hip bone after medicine has been given to numb the skin. For a bone marrow aspiration, a special needle is inserted through the hip bone and into the marrow to remove a liquid sample of cells. For a bone marrow biopsy, a special needle is used to remove a core sample of bone that contains marrow. Both samples are examined under a microscope to look for chromosomal and other cell changes. See Health Terms on page 42. Cytogenetic Analysis. This test measures the number and structure of the chromosomes. Samples from the bone marrow are examined to confirm the blood test findings and to see if there are chromosomal changes or abnormalities, such as the Philadelphia (Ph) chromosome. The presence of the Ph chromosome (the shortened chromosome 22) in the marrow cells, along with a high white blood cell count and other characteristic blood and marrow test findings, confirms the diagnosis of CML. The bone marrow cells of about 90 percent of people with CML have a Ph chromosome detectable by cytogenetic analysis. A small percentage of people with clinical signs of CML do not have cytogenetically detectable Ph chromosome, but they almost always test positive for the BCR-ABL fusion gene on chromosome 22 with other types of tests. page 12 I 800.955.4572 I www.LLS.org

 

FISH (Fluorescence In Situ Hybridization). FISH is a more sensitive method for detecting CML than the standard cytogenetic tests that identify the Ph chromosome. FISH is a quantitative test that can identify the presence of the BCRABL gene (see Figure 5). Genes are made up of DNA segments. FISH uses color probes that bind to DNA to locate the BCR and ABL genes in chromosomes. Both BCR and ABL genes are labeled with chemicals each of which releases a different color of light. The color shows up on the chromosome that contains the gene— normally chromosome 9 for ABL and chromosome 22 for BCR—so FISH can detect the piece of chromosome 9 that has moved to chromosome 22 in CML cells. The BCR-ABL fusion gene is shown by the overlapping colors of the two probes. Since this test can detect BCR-ABL in cells found in the blood, it can be used to determine if there is a significant decrease in the number of circulating CML cells as a result of treatment.

 

Normal Abnormal Polymerase Chain Reaction (PCR). The BCR-ABL gene is also detectable by molecular analysis. A quantitative PCR test is the most sensitive molecular testing method available. This test can be performed with either blood or bone marrow cells. The PCR test essentially increases or "amplifies" small amounts of specific pieces of either RNA or DNA to make them easier to detect and measure. So, the BCR-ABL gene abnormality can be detected by PCR even when present in a very low number of cells. About one abnormal cell in one million cells can be detected by PCR testing. Chronic Myeloid Leukemia I page 13 Quantitative PCR is used to determine the relative number of cells with the abnormal BCR-ABL gene in the blood.This has become the most used and relevant type of PCR test because it can measure small amounts of disease, and the test is performed on blood samples, so there is no need for a bone marrow biopsy procedure. Blood cell counts, bone marrow examinations, FISH and PCR may also be used to track a person's response to therapy once treatment has begun. Throughout treatment, the number of red blood cells, white blood cells, platelets and CML cells is also measured on a regular basis (see Measuring Treatment Response on page 26).

[Trey]

Ask the Onc to write down:

1) PCR and/or FISH at diagnosis

2) PCR and/or FISH now

 

Tell us.