Hi Everyone.,
I have been diagnosed with CML - AP few weeks back. @ Dx my WBC count was 215000 and blast % (BM) - 12%. BCR-ABL - RT-PCR : 88%.
I am on Nilotnib 400mg BD since 2 weeks. WBC has come dow to 6600 and so do RBC and Platelets.
Few questions :
1. Is Blast % from Bone marrow - 12% considered to be CML-AP or CML - CP?
2. Is BCR-ABL/ABL % -of 88% too high?
3. Is there a corelation between WBC count and BCR-ABL%.?
Kindly help me understand
Regards
Kiran
Hi Kiran,
There’s no single accepted definition of accelerated phase. Sometimes one metric that’s used is the blast % - and between 10-20% may be considered AP. However most clinicians would also need to see things like anaemia, very large spleen, and very high / low blood counts to treat the CML as AP. The CML disease of course does not care for our definitions, so you need a good clinician to make the right judgements.
88% BCR-Abl is not especially high. Depending on how it’s measured, it’s possible to be at more than 100% at diagnosis. Do you know if the test that came to 88% was a FISH test or a PCR test?
Regarding a correlation between WBC and BCR-Abl I can’t give you a definitive answer on this but as CML progresses untreated both the WBC and BCR-Abl will increase so I suppose there is a correlation in many cases but I can’t tell you if there is any accepted ratio (I think not). You do see some cases where there BCR-Abl is high but the WBC isn’t really that high.
David.
Thanks David.
88% Bcr Abl is PCR test - with normilized IS standards.
Yes, my spleen was 22 cm at dx. Not sure if its considered very large.
I was on hydroxyurea for a week to bring down the wbc count under control.
I am on Nilotnib since 2 weeks. Will my wbc count stabilize. Currently it around 6600.
Regards
Kiran
1. Is Blast % from Bone marrow - 12% considered to be CML-AP or CML - CP? 10 - 19% is accelerated phase which is likely why you were started on Nilotinib.
2. Is BCR-ABL/ABL % -of 88% too high? No, some people have had over 100%.
3. Is there a corelation between WBC count and BCR-ABL%.? I don't believe so as my WBC count was much higher (375k at diagnosis) and my BCR-ABL% was 66% (58% International Scale).
