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Transplant or not for CML


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#1 tckeats

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Posted 09 May 2010 - 09:11 PM

Hey folks... I read these boards often but I do not post much.... I but I felt I needed to share... I was diagnosed with cml may 0f 2002. I started on gleevec and in six months was negative by my six month marrow. Gleevec although it out me in ocr was horrible to be and I had continued nausea, vomiting and weight loss. I stopped gleevec in 06/2007. I wa on no drugs untill 10/2007 when my cml recurred. I started sprycel in oct 2007 but developed serve headaches. I once again reached cyctogenic remission but had to have the dose of sprycel reduced and the it was stopped once my cml reoccured in sept of 2008. I then started tasginia in Oct 2008 but I never responded to it and it was discovered that I had a bcr-abl mutation with a 35 nucleotide insertion between exons 8 and 9. Because I failed to respond to tasginia I was placed back on sprycel in june of 2009 by sept I was showing negative by both pcr and fish. I have since lost that response and I am once again showing positive... all though a very low number..... I am not at a crossroads... sprycel is holding my cml at bay for now but the thought and fear is we don't know for how long.

I am on 70mg of sprycel and the side effects have been really difficult to deal with. They are suggesting because of my history that I proceed to transplant given that I am flucating in and out of pcr, the side effects that I have had with these drugs and that i have a mutation that no one knows anything about.

I do have a 10/10 donor but I am unsure of what to do. I am only 38 years old... I work full time, I am single. I don't know whether to pursue transplant or wait for a new drug to come down the pipeline...

Sorry for the long post but I needed to vent... I am scared and unsure which path to take... Also does anyone know or heard anything about this mutation that I have... Help



#2 Trey

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Posted 10 May 2010 - 09:22 AM

Your issue is called an "insertion/truncation mutation".  It means that your version of Philadelphia Chromosome formed a little differently than the regular version.  Here is some information about the 35 nucleotides from ABL intron 8 inserted at the  normal exon 8 to 9 splice junction:

http://jmd.amjpathol.org/cgi/content/full/10/2/177

The article describes 3 patients with this type of BCR-ABL, and each responded differently to CML drugs.  So it does not necessarily mean that it will cause drug resistance.  You are actually responding well to Sprycel, and except for the side effects, the drug seems to be working.

Transplant should be on the list of available options, but it has moved way down since the CML drugs came along.  There are more drugs in the pipeline.

You should show your Onc the article above, abd since Dr Druker was a co-author, your Onc should call him, or you could email him yourself.

http://www.ohsu.edu/xd/health/services/cancer/about-us/druker/






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