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NCCN 2/2017 guidelines include discontinuation guidelines

Started by tiredblood , Jun 19 2017 02:48 PM

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7 replies to this topic

#1 tiredblood

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Posted 19 June 2017 - 02:48 PM

Did I miss this on the discussion board? I was looking at diagnostic criteria for MM and decided to look to see if there were any updates on CML.

Didn't know that they had added criteria for discontinuation of TKI.

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#2 kat73

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Posted 19 June 2017 - 04:25 PM

I would like to print out the 2017 NCCN guidelines for CML, but I've never found an online source that would let me do that for free and without signing up/logging in to something. I, too, would like to know what they've added on the subject of discontinuation. Can anybody point me in the right direction for being able to find and download them?

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.

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#3 gerry

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Posted 19 June 2017 - 05:19 PM

It may take a little while for the information to get into the Patient version on the NCCN guidelines. Figure they have to work out how much and exactly what they think we should know about cessation.

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#4 tiredblood

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Posted 19 June 2017 - 06:58 PM

Just create a login. It's free.

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#5 Sandrea

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Posted 20 June 2017 - 01:01 AM

I would like to print out the 2017 NCCN guidelines for CML, but I've never found an online source that would let me do that for free and without signing up/logging in to something.

I'm not sure, maybe this?

Diagnosed 1 April 2015. WBC 86000; b2a2 (p210) transcript

on Hydrea for 2 months, then generic Gleevec 400mg (06/06/15)

CCyR in April 2016

12/22/2016 PCR: 0.49% (IS) 18 Month

03/29/2017 PCR: 0.68% (not IS) 21 Month

06/06/2017 PCR: 1.62% (not IS) 24 Month

06/20/2017 increased dose of imatinib to 600mg

10/30/2017 PCR: 0.15% (not IS) 28 Month

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#6 AdamJ

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Posted 20 June 2017 - 01:44 PM

I'm not sure, maybe this?

Thank you for sharing this Sandrea.

3/23/2016 Dx PCR 93.4399% IS, FISH 87%
3/30/16 Sprycel 100mg
4/15/2016 liver toxicity and a brief stint on Tasigna 600mg book-ended by drug breaks
6/6/2016 resumed Sprycel at 50 mg increased to 70 one month later followed by 100mg
6/17/2016 FISH Test 2%
8/22/2016 PCR 0.0035% IS
11/7/2016 PCRU
12/29/2016 PCRU
4/5/2017 PCRU
6/28/2017 PCRU
10/26/2017 PCRU

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#7 kat73

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Posted 20 June 2017 - 04:30 PM

Thanks, Sandrea, that worked!

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.