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Question regarding timeline for log reductions

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#1 nathaliece


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Posted 27 March 2011 - 06:32 AM

I am new to the CML world having been diagnosed in 11/10. I am on 400mg Gleevec and have worked hard to remain positive.  My regular oncologist sent me to meet with a BMT specialist for a long term treatment plan a couple of months ago.  The specialist was the one who told me that I needed to have a PCR test every 90 days and that I needed to achieve a 2 log reduction by 12 months and a 3 log reduction by 18 months.  My regular oncologist says my first PCR indicates a 2 log reduction and that I am "just on track".  It would seem like I am ahead of schedule and when I asked him, I did not get a straight answer.  I am changing oncologists this week because I have a lack of confidence in the current oncologist who appears to lack experience treating CML.  I am curious about the milestones a CML patient should achieve.  Is a 2 log reduction the goal for one year or is it merely "on track" at 90 days?  Trey, you were so helpful with my earlier questions.  Any advice would be very much appreciated.


#2 hannibellemo


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Posted 27 March 2011 - 08:16 AM

Hi, Nat,

Thought you might find this light reading useful.   http://community.lls.org/docs/DOC-1213

As you can see nothing is said about a 3 log reduction, or Major Molecular Response, although that would be very, very good. The expectation is a CCYR, or 2 log reduction, by 18 months, in which case you are way ahead of the game!




"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>

#3 Trey


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Posted 27 March 2011 - 09:10 AM

Treatment milestones for CML are not firm rules, but more of a general approach that faster response is considered to be better response.  But most slower responders also do very well over time.  The NCCN Guidelines for CML Treatment that Pat referred to are a good reference.  You would like to see a CCyR in 12 months (roughly equivalent to a 2 log reduction), but sometimes that goal needs to be modified to account for low blood counts which can require frequent drug breaks and lower dosages.  Some Oncs set out more aggressive goals, and the rationale is that they can switch drugs if these goals are not met, so your Onc seems to take this approach.  When Gleevec was the only TKI drug available, the goals were generally not as aggressive since there were no approved drug alternatives.  Overall the answer is that the goals are flexible.  If someone achieves CCyR in about a year or so, they are generally considered to be making acceptable progress.  But with 2 additional drugs now available, if CCyR is not achieved by 12 months an Onc may want to consider switching drugs just to see if that helps achieve faster response, and often it does.

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