My logic says, the higher the WBC at dx, the higher the leukemic burden. However, this does not always appear to be so. I just read about a patient dx with WBC around 450K, on hydroxyurea for 3 months, and was PCRU within 4 months on Gleevec, (so this person reports). Aside from other variables, like undetectable mutations, one's biological response and synthesis of said TKI, I have read about people who had WBC and are not even at MMR years later. So why does this happen? It also seems that people dx with lower WBC have a faster response (especially on Gleevec). Thus, continued success on G = success overall (so it appears).
From what I read, people who respond fairly quickly generally do the best overall (but G has been around longer than the other drugs, thus studied more). And Sprycel seems to produce a speedy MMR in many as a first line therapy and also for those who have a slow response to Gleevec, (esp. on this site).
So, is it possible that a high WBC at dx does not mean a high PCR?
My PCR at six months was 13.something %. Since I have no dx number, I assume my leukemic burden was much higher than most CMLers at dx. Perhaps higher even than those dx with much higher WBC? A higher leukemic burden at dx, possible mutations, or my body just does not synthesize the TKIs with great efficiency, are the only things I can come up with as to why some people with higher WBC at dx sailed to MMR or PCRU as opposed to moi. Any thoughts?
P.S. Of course, this is all about me, but I was just wondering what the current thoughts are (if there are any). I was dx at 180K, given hydroxyurea for about 3 weeks, then given G, 400mg. My PCR stopped moving at 9 months, so I was switched to Sprycel. I reached CCyR at 1 year (after 3 months on Sprycel), but things are going very slowly, (I have been dx with CML for 19 months now). Just cannot help but wonder why others on this site, who were dx with higher WBC are now MMR or PCRU (and at least 1 person is at less than the standard dose of Spycel and having success in less than a year----I am a slug at the average dose of 100mg).