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BCR-ABL count started to Increase - Tasigna 300 BID

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I was diagnosed on late Dec 2016  at age 38 and started Tasigna 300 BID from Jan 2017 . Everything was working fine till Aug 2018 . Last three lab results are as follows. BCR_ABL on Aug 2018 = 0.014 ,  Nov 2018 = 0.027 and March 2019 = 0.041 . ( these are all International scale, I am in United State)
I will have my doctor visit on coming Monday ..i think he will suggest to go for higher dose 400mg BID .

Have any of u who is/was taking Tasigna has such issue .
Any suggestion. I am little scared .

Thank you

Rather than whack up the dose, why not discuss trying another TKI? Dasatinib is very good, works against most mutations and is easier from a patient compliance perspective by a mile. 

I think people make a switch to be a bigger deal than it really is. You can always switch back. 

Cranking up the dose can cause more side effects. 

All that said, your results are still very good and in all honesty I'd stick to what you are doing. You have gone from a rate of 1 in 100,00 cells to 4 in 100,00 cells. Not actually that big a change really. Perhaps worth hanging on for one more result before changing anything?

David

Agree with David.  Your last 3 results are excellent are all within the statistical error rate (.5 log) of the PCR test, i.e identical.  I would only change dose and/or TKI only if you lose the first zero to the right of the decimal place, particularly if you are tolerating Tasigna well. If your doc suggests a higher dose given your current levels, you might want to get another doc.

I started on same dose as you and did not tolerate it well at all, but had excellent response and have since reduced dose to 150 mg 1x/day. Good luck

I completely concur with David and cmljax on all their points.  Hope we've helped you to not feel so scared.

David

 

Thank you very much for your quick reply and encouraging words.. I am also leaning toward the Dasatinib  rather than going up in the dose.

cmljax,

Thank you ..

I have been following your post and you are doing so well with Tasigna . Earlier I was also hoping to reduce the dose in future ..but these recent increasing trend is not suggesting that at least for near future..

 

Kat73:

you guys are making me relax ...Thank you !!

 

I will keep you guys update on what my doctor says on Monday.

Regards

Naj

I’ve been on Tasigna for five and a half and it’s taken all this time to get to 0.025! I’ve had many episodes of it

fluctuating up and down and my haematologist has never been concerned. You’re doing brilliantly! 

Debbie,

Thank you for sharing your experience. Much appreciated. It certainly does provides some relief.

Regards

Naj

If your next PCR improves, you should seriously consider less dose.  I reduced from 600 to 450 mg/day when I hit MMR = .1 and my PCR continued to go down. We are all different, but there is growing evidence that at least with Tassigna and Sprycel, less may actually be more.  

Cmljax,

I just had a visit to my oncologist this morning and like all of you guys mentioned on this post, he said I am doing fine . He suggested to be on the same dose for now. I will have next lab done in 3 months and hope the result will be better or at least steady.
I will definitely go for lower dose in future if my number allows.
It will be a great relief if I could also take just once a day like you ...right now twice a day with fasting time is not that convenient for sure. I am taking mine at 5:30 am and 5:00 pm so far.

Regards
Niranjan

Naj,

Consider switching drugs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142480/

... only because you prefer not to deal with fasting before or after taking tasigna.

if you switch to sprycel, however, do so at a lower initial dose (50 mg or lower). You may find your PCR plummet because of the ideas mentioned in the above paper. You can always switch back. Discuss with your doctor.

Scuba,

Thanks for the paper.. I am thinking about Sprycel for some time. I will talk about this with my doctor at some point.
Initially I was hoping I can lower Tasigna to just once a day like Cmljax ..in that case fasting wouldn't a big issue . However as per the recent few results that road looks like a long one..

Regards

Naj