Hello all, I have had CML now for 8 years caught early and results are typically good and generally well tolerated (On Imatanib 400 mg.) I have the PCR testing every 6 months now and % results are generally between .001 and .015 and they have gone up and down between these over the years which I understand is typical. The lab results also show the BCR-ABL transcripts / 3.0 ul CDNA which typically are between 1 to 3. This time though they came out at 7 but the ratio was still 0.011% (up from .003% the previous time). 7 is the highest number I have seen since I can remember. (FBC was fine) Does this mean anything and is the increase in (molecules ?) to 7 a significant enough level to take note? Should I ask the Dr to redo the test sooner rather than wait the usual 6 months? They didnt ask me to come in earlier so I wonder if I am just over worrying. Interestingly the only thing that I have changed is I started taking mebeverine and maybe I take it too close to the tablet as I take it 20 minutes before I eat and I take the tablet during my meal. If I might also ask, in regards to "ABL control" which seems to vary quite a bit from test to test. This time it is 6.38 x 10(power of 4) sometime is something like 3.88 x 10(power of 6) or 2.44, etc - it varies quite a bit. I would be grateful is someone could also let me know what this is and why the control are not always close in size. They come from the same lab each time. I do apologise in advance for all the questions and would like to comment that while I am not a regular poster to the site. I am a reader and it is a great asset to the CML community and comfort to know it is there when needed. Many thanks, Bill
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Questions about interpreting Lab results
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Hi Blll,
You might like to read our PCR primer... link at the bottom of the left hand menu.... which might explain some of the intricacies of PCR analysis etc.
I think that your results look very stable in spite of the varied 'blips' back and forth between tests. It's hard for us all not to become fairly obsessed with the differences between one result to the next but remember that we are seeing the presence of Bcr/Abl1 on the molecular level so these are really tiny numbers.
Regarding the transcript levels, these do vary with each sample taken and the surviving transcripts in the sample when it arrives at the lab can depend on how the sample it treated on its journey, how long that journey is and how long it is stored before testing. The PCR tests relies on extracting RNA from the sample- RNA molecules start to degrade very quickly as soon as the blood sample is taken- so you may end up with very few. The control gene used by the lab will also need to be present in the sample in a large enough number (min 10000 transcripts) to give a meaningful result.
Of course, as the abnormal gene (BCR-ABL1) reduces and is kept at very low molecular levels by Tki therapy over the longer term, there will be more of the normal ABL1 transcripts in a sample.
It may be that the drug you mention (for treatment of IBS?) may be having an affect so you could also try increasing the interval between when you take that and when you take imatinib- but this may be a problem as you need to take both with food?
If you are worried, then maybe you should ask your doctor to repeat the PCR test before your usual 6 month schedule, but it may be that he/she may just need to take you through the levels of normal vs abnormal transcripts in your tests over time and so put each 'blip' into context for you.
Hope this helps a little.
Sandy