5 replies to this topic

[random]

Hi everyone,

I was wondering if there are some known cases of persons with CML that even if being under drug treatment and with low chromosome  and OK leukocytes values CML progressed to some advanced stages? I mean, is this possible with the actual CML medical knowledge?

What are the signs of CML advancing?

Thank you!

[valiantchong]

Advancement of CmL progress is marked first by the PCR value then WBC will go up and lastly blast cells % of WBC will increase also. Normaly in advance stage blast cells will go up to > 10%. So it is important to monitor the PCR coz PCR is the very first sign to increase.

Again the above only express what my understanding, pls refer to the doctor for confrimation as I am no doc.

[Trey]

When you say "CML advancing" you are discussing CML progressing from Chronic Phase to Accelerated Phase and then Blast Phase.  Drug resistance does not fall into this category in most cases, since another drug will normally work to keep the patient in Chronic Phase.

For CML to advance, it will first morph in some way that makes it more aggressive.  In that way it begins to act like an acute leukemia, moving quickly and not responding very well to TKI drug treatment.  If this is going to happen, it will likely happen during the first couple years after diagnosis, with the higher probability during the first year.  Even then the statistics are quite low for disease advancement.

It is a controversial issue whether low blood counts along with increasing blast count alone represents an advancement in disease phase.  Oncs assume that it does.  Although the term "blasts" in leukemia is assumed to always be bad, it is not.  There are good blasts and leukemic blasts.  Good blasts are a sign that the body is trying to fix the low blood count problem by making lots of new cells, and blasts are a stage in that blood making process.  This would just be a somewhat short spike in blast count.  But increased leukemic blasts are a possible sign of disease acceleration, although traditionally Oncs would also look for other signs such as increased basophil counts and so forth.  So blasts are only a problem when they are leukemic, but Oncs do not take the time to figure out if they are or not.  That is a bad practice.  If blasts are increasing but FISH and/or PCR from the marrow are not, then I would not call that a problem.  It is an issue that needs more research to define which is which.

[tranier]

Valiant-While my 21 year old son, BJs case is rare...I want to caution that there was not an increase in WBC  count when he entered blast crisis...also the docs did do emergency bmb to be certain they were leukemia blasts....what did happen that w

e know is that there was a second translocation...9 also switched with 11 ....no signs or warnings...but plz folks remember his is a very rare case...dx fall..09...blast crisis June '11...also that the bcr-abl was dedected again...after not being detected from 3'10 onward...fish..CPR and bmb...it was not a case of neglect by xml docs nor did my son not take meds..his goal was to get back in college football field again

[Tedsey]

All my counts have been very low since starting TKIs (been on G & now S).  I have been dx almost 2 yrs.  My last PCR (Aug '11) went up a little and so did my blasts (but there was no differentiation btwn leukemic cells and non on the report).  The pathologist felt that since I am pancytopenic, that the BMB just caught my marrow generating new blood cells.  That, she thought, was reason for the increase in blasts (from her mouth into God's ears).  My BMB before this last one showed no increase in blasts like the one before and before that, and I was even more pancytopenic than I am now.  I am not sure how often the generation of new cells (mitosis) is caught during a BMB.  The only explanation for the last PCR increase was either normal flux or, in the worst case, the start of losing response.  An upward trend over time or a quick log or two jump would show that I am losing response to Sprycel, (God forbid).  Right now, I am still CCyR and seem to be stable.  Both with G and with S my PCR stayed flat after 9 months.  This is the first time I have ever seen my PCR jump upward.  Little scary, but it may not mean anything.  It is just that I am not MMR, so it is a little more nerveracking because my PCR is not super low where if I saw a slight uptick, I would be much less anxious.

This is such tricky business.  Especially since it is so hard to determine what a leukemic blast/cell really is.  But I guess there are some good guesses out there from credible sources.  It IS scary that there are some lazy oncs out there who just throw people into BMT when it may not be necessary and more harmful than good.

All the best,

Tedsey

[valiantchong]

Hi,

Understand the point, that why PCR measurement is very important, if there is a sudden increase, the doctor will need to do a cytogenetic and differentiation on for the blast cells, if increased to > 5% (initialy). The cytogenetic will showed any other special translocation other than 9.22 and other special deletion. Which might showed a early sign of progression to ALL or AML.

Anyway I wish all the best for your son recovery and will have a successfull treatment.