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Importance of preventing progression - summary from Oncology-live


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#1 scuba

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Posted 29 January 2016 - 05:09 PM

Nice summary of current thinking in CML treatment:

 

http://www.onclive.c...gression-in-cml

 

from the article:

 

"The most important goal of therapy "is the prevention of progression to accelerated phase and blast crisis," stressed Erba. "It's really important for the community oncologist to know that when we're talking about progression, we're not talking about losing a response and the white count goes up again."

Rather, Erba said, "progression means that the biology of the disease has changed. The outcome of these patients is worse. Their survival is worse. They're facing decisions about allogeneic transplant in that position, and when patients progress to accelerated phase or blast crisis, their median survival is about 10 months, So prevention of progression becomes the most important goal in my book, and treating patients with an agent that they can tolerate to do that is important." Two large randomized controlled trials have shown that second-generation TKIs have fewer progressions to accelerated- or blast-phase disease compared with imatinib".

 

 

This caught my eye:

 

"Although there has been discussion about whether selected patients might be permitted to discontinue pharmacotherapy, at present and outside of clinical trials the word on TKI discontinuation is "don't try this at home," said Pinilla-Ibarz. Of course, the situation might be different if a patient wants to become pregnant. In that situation, Kelly might discontinue but first "would like to see a complete molecular response that's sustained preferably over a 2-year period." Thereafter, he would monitor "very carefully" because "they can relapse—even late after discontinuation— with lymphoid blast crisis.""

 

- See more at: http://www.onclive.c...h.1FloDLWT.dpuf


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"


#2 missjoy

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Posted 29 January 2016 - 06:41 PM

Thank you so much for sharing this article with us!

#3 Frogiegirl

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Posted 30 January 2016 - 11:47 PM

Scoobs.......that article scared me. But maybe it should. I realize the risk I'm taking when I do get pregnant, but thought I understood that even if cml progressed I would be able to possibly control it on interferon, and then re starting my tki after delivery. Also my doc is the one that suggested being pcru for only a year was ok. But noted in the article it's two years. I didn't realize it could progress as lymphoid crisis. So much to still learn. ...uuhhggggg

Diagnosed Oct 2013 Started 600mg of Tasigna  on Nov 4th. Lowered dose a few months later to 300mg due to side affects stayed here declining PCR until March 2015 small jump from 0.0072 to 0.0083 scarred my doc into full dose of Tasigna again 600mg(been miserable since) but reached PCRU 06/15/2015(next test) and have been there ever since. Hoping to have another little one. I have the support of my doc to go off anytime, just scared to jump. might go two years PCRU but he said it wont make much of a difference. I just figured I could possibly go into a trial while preggers if I got the two years behind me.

Nov 8th 2017 went off Tasigna

Dec 1st PCRU off TKI

Jan 5th PCR Detected .0625

Feb 1st PCR Detected .7815

Added 8-6 grams Curcumin daily in Feb

March 3rd PCR Detected 3.2646 YIKES!

 stopped trying for baby after February reading. will start new TKI march 16th 2017 (Sprycel)

FYI I'm not done trying for my last little one.


#4 scuba

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Posted 31 January 2016 - 09:19 AM

I wouldn't be too concerned. The risk of sudden progression to Lymphoid blast crisis rare and when documented was associated with other comorbidities by the patient (i.e. very old people who are very sick to begin with). You are not in that situation.

 

The key here is being monitored once a month and verifying no increase in PCR.

 

In another article I posted - the reserchers are now suggesting that one year PCRU may be enough for second line TKI's.

 

It's my opinion that achieving a deep molecular remission (PCRU) may be all that is needed for many patients to have beaten CML. We just don't know who will stay in remission and who will relapse after cessation.


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"





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