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PCR surprise

I never cease to be amazed - my PCR has just come back at o.oo3 again having wobbled up to o.o15 three months ago. As I have been taking Glivec for 12 years one would think I would have got used to PCR results by now - but they always still keep me on edge! I always seem to live in three monthly blocks between my PCR results! My fatigue problems are fairly new and ongoing - it was suggested I might try taking 400mg Glivec rather than the 600mg I have taken for many years but that a careful eye would need to be kept on my PCR. My instinctive reaction was not to do this. Am I being the opposite of brave! Best PCR wishes to you all. Pat P.

Hi Pat,

Given that your molecular response to 600mg is so good.... even your 'higher' result 3 months ago is at MR4 and was probably more to do with the test sample rather than your actual levels of BCR-ABL.
0.1% BCR-ABL = MR 3 (3 log reduction from 100% - IRIS)
0.01% BCR-ABL = MR 4
0.0032% BCR-ABL = MR 4.5
0.001% BCR-ABL = MR 5

According to the above % drops your latest result shows you are back to MR4.5. Pretty low by anyone's standards. I would say that should you want to try reducing your dose -due to increase in fatigue etc. which is the most commonly reported side effect of imatinib- you do not need to be 'brave' or even scared. Given your disease is responsive to TKI therapy- as shown by your results- you would very probably keep you response even to the reduced dose. As you say, you would continue to be carefully monitored so then there is little risk that your PCRs would be allowed to rise above MR4 without a re-introduction of 600mg.

There is continuing (and very interesting) academic research that shows there is a continuing reduction of leukaemic cells over 3 and possibly 4 time-points in patients treated with imatinib over 10 years.
There is a quite complex (for the layman/woman)paper published in Blood which I have put on the home page for those who are interested in this.

'Dynamics of chronic myeloid leukemia response to long-term targeted therapy reveal treatment effects on leukemic stem cells'

Congratulations anyway Pat... if I were in your shoes I would try the reduction to 400mg, but then I might just be more of a risk taker than you. ;o)

Best wishes,
Sandy