8 replies to this topic

[ROM1212]

Hey gang.

PCRU since April 2009.  Went in for my usual CBC today and for the first time my Onc used my low Hemoglobin nos. as a reason to perform a BMB.  She said this was necessary to further look into my low nos.

My Hemoglobin going back to 2009 has consistently been in the range of 12.3-12.5.  So if I am PCRU, and Hemoglobin has been steady, albeit low, I don't see the necessity of doing a BMB.  Unless the cancer center is looking for ways to fund their recently completed expansion/remodel?

Is a BMB necessary?  I say no.

Thanks for your input.

[hannibellemo]

Many of us would love to have your Hgb! I would not consider this a reason to have a BMB. How many BMBs have you had since 2009? I am MMR and will have my 3rd in 3+ years in Feb. 2012; I don't consider that excessive. It will be interesting to hear what others think.

Pat

[Trey]

BMB is not considered necessary after CCyR (negative FISH, negative BMB cytogenetics, or -2 log PCR) unless there is a significant change is status such as loss of CCyR.

[hannibellemo]

Excellent! Is there a paper or something I can site when I relay this info to my onc?

Pat

[CallMeLucky]

You can download NCCN treatment guidelines here http://www.nccn.org/..._guidelines.asp

Page 10 defines Monitoring for patients receiving TKI Therapy

Take note of the following sections

Diagnosis of CML

• Bone marrow cytogenetics and measurement of BCR-ABL transcript numbers by QPCR before intiation of treatment.
• If collection of BM is not feasible, fluorescence in situ hybridization (FISH) on a PB speciment using dual probes for the BCL and ABL genes is an acceptable method of confirming the diagnosis of CML.

Treatment Response

• BCR-ABL transcript levels should be measured every 3 mo.
• Bone marrow cytogenetics at 6 and 12 mo from initiation of therapy.  If complete cytogenetic response (CCyR) at 6 mo. it is not necessary to repeat bone marrow cytogenetics at 12 mo.
• Bone marrow cytogenetics at 18 months if patient is not in a CCyR at 12 mo.

Complete Cytogenetic Response

• BCR-ABL transcript level should be measured every 3-6 mo.
• Bone marrow cytogenetics as clinically indicated.

Page 46 goes on to say a bone marrow test should be done for the following indications

• At diagnosis to establish the stage.  If collection of bone marrow is not feasible, FISH on a peripheral blood specimen using dual probes for the BCR and ABL gene is an acceptable method of confirming diagnosis of CML.
• At 6, 12, 18 month from intiation of therapy to assess response to TKI therapy.  If a CCyR is acheived at either of the earlier time points, then cytogenetics do not need to be repeated.
• Rising levels of BCR-ABL transcript (1 log increase) without a MMR.

[Trey]

Bravo.

[GerryL]

Hi Pat,

I just got to MMR and I'm only having PCR blood tests now - not due for another one till October, 4 weeks before my appointment.

I did ask the doc if the blood test indicated lower levels of BCR-ABL than a BMB - he said that was correct.

Gerry

[hannibellemo]

Thanks, Lucky, that's a great source! And, GerryL for the info!

[hwccritch]

I would question the need for BMB if your other critical blood values are normal