Rising FISH %

Hi Jason,

It is my understanding from a brief online search is that FISH testing has improved over the last decade or so. Improvements in FISH (Fluorescence in situ hybridization) testing seems to have reduced the false positive/negative % from just under 14% to 0.4%. 

I am surprised that you will not have another test until 24th Sept. Where are you being treated and with which TKI?

Sandy

Latest Fish test on 24th still rising at 78%. I fired my Dr and will be seeing a new one tomorrow. Will be asking for sprycel, fingers crossed the cml hasnt advanced to another phase

Jason,

FISH rising is not a good sign. Your previous doctor should never have let it rise like this and keep you on the same drug. Tasigna is NOT working for you. Tasigna and gleevec are very similar compounds in how they work. The key difference is that tasigna binds to the ATP socket more completely helping to shutdown bcr-abl energy draw in CML cells thereby killing them. So patients who respond somewhat to gleevec usually will respond much better with tasigna. But patients who do not respond to gleevec usually won't have success with tasigna.

Sprycel works differently and binds to a different site in higher order cells. Where tasigna fails, sprycel often works. Switching drugs right away is the correct path.

FISH is the single most important measure of CML treatment success following diagnosis. It is vital that FISH numbers fall continuously once treatment is started. At ANY time when FISH results plateau or rise during treatment, the TKI chosen must be re-evaluated and perhaps changed. One month is all I would allow to verify treatment failure when it comes to FISH. Your goal is for FISH to go to zero as quickly as possible (< 18 months) continuously following diagnosis.

Choosing sprycel is a good choice because it works differently than gleevec and tasigna. I would caution however, that full dose 100 mg may not be wise. Consider a starting dose of 70 mg (discuss with your doctor) and track at one month your FISH response. More sprycel is not necessarily better. If sprycel is going to work for you, you should see a dramatic drop in your FISH number. If that happens LOWER your dose to 50 mg. and track again. If your trend continues down, then stay at that dose until your FISH goes to zero. Once FISH is zero, tracking your response using PCR is the next step and you may be able to lower your sprycel dose further. A considered lowering of sprycel once trend down is achieved is so that you can potentially avoid sprycel side effects such as pleural effusion and/or myelosuppression. Discuss that with your doctor as well. Also if you do experience myelosuppression (especially neutrophils and/or platelets), it could actually be a sign of excellent response - you should definitely lower dose when this occurs.

You are going to get there.

Did your new doctor start you on a new drug in the mean time?