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What does log increase mean?
Thanks Julia going see her tomorrow glivec making me depressed esp on 400 mg so will discuss it with her.
Tanya a 1 log increase means you BCR-ABL result has increased by a factor of 10, so if it is now 4 I assume it was around 0.4 at the previous test. Can you tell us how long ago that was? The repeatability of the test is around +/- half a log, so this would seem to be a bigger issue than many where a small increase is explained by the test accuracy range, and a subsequent test shows a continuing downward or stable trend. I assume they will take another BCR-ABL sample at your imminent appointment, and would suggest that no decisions are taken until that result is known. By all means go through with the doctor what should be done depending on what the result is, but if the results is going to be a week or two I think worth waiting and seeing. Hope this helps.
Tanya,
A one log increase in your bcr-abl test is likely real. I suspect Gleevec is not working for you any more. I would encourage you to switch drugs - either to Nilotinib or dasatinib (sprycel) and do so right away. Sprycel would be better because it works differently than Gleevec and is much more potent. Nilotinib is very similar to Gleevec in that it binds to the same site in CML cells, just more tightly.
You likely do not need full dose sprycel. I would ask your doctor if you can start on 70 mg first and quickly drop to 40 mg if you show good response in one month. Gleevec helped clear out a lot of CML from your body already. The cells that are left are not responding to Gleevec (my interpretation) necessitating a drug change. Sprycel will attack higher order cells (closer to the stem cells) and likely help you resume your trend down (and keep it there). Many patients who make a switch at your situation do extremely well.
I am one of them.
I started on Gleevec at 400 mg - but could not tolerate it well (myelosuppression) and was lowered to 300 mg - which led to an increase just like you experienced. I even had to stop Gleevec altogether to let my blood counts recover (and bcr-abl jumped way up). I was started on 70 mg Sprycel and within one month dramatic drop in bcr-abl. I kept lowering my dose to where I am on only 20 mg sprycel today and I am PCRU (currently). It's the low dose of sprycel that will help you avoid the side effects (pleural effusion). New research is strongly suggesting that 100 mg starting dose is too high (toxic). Tell your doctor this information. If your doctor doesn't know - you may need to change doctors.
You are going to be fine. Just a few blips in your way to permanent remission. You'll get there, but be vigilant during this transition.
Saw haemo ...wanted me start on 100 mg sprycel but told her bout the 70mg and then the drop to 40...she had not heard of that!Hope it does as its meant to and will let you know!
100 is very strong. Have a blood test in one week (CBC) to check that your blood counts are not dropping too fast - especially neutrophils.
Myelosuppression is a side effect of sprycel that usually resolves (with lower dose). Also - you may get headaches initially. They only last a few days and will go away. I take sprycel at night before sleep. Be careful at the high the high dose. More is not better when it comes to dasatinib. It is a threshold drug. You have to find the correct dose that works for you.
http://ascopubs.org/doi/abs/10.1200/JCO.2017.35.15_suppl.e18551