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Pancytopenia and Nilotinib

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I am a 51 year old female diagnosed with CML in the Chronic phase in January of 2017. I feel certain it was a result of radioactive iodine treatments that I had for thyroid cancer six years ago.

I was initially on Imatinib but was intolerant and switched to Nilotinib 300mg twice daily. I have been on it for a year and tolerated it very well. My PCR was at .005. I was trying to get to undetectable. However, since February my WBC has started to drop. They finally took me off Nilotinib on March 23rd. I have been off it for a month and my WBC is at .72 and ANC is at .16. My RBC and Hemoglobin are starting to go down as well. I have a bone marrow biopsy scheduled for May 8th. 

Has anyone had drug toxicity this late in the game? If so, how long did it take you to rebound?

Praying it’s drug toxicity. I know it could also be worsening of disease, MDS, aplasia, another cancer, etc

 

Please try not to worry too much about whether this is signs of worsening CML or some other cancer etc. It is more than likely to be due to drug toxicity. Your PCR was pretty much in the realm of 'undetectable'...  a result of 0.005% is an optimal result.

Stopping nilotinib until your blood counts start to normalise again is the best -only- thing to do. It may well take some time for you to see better counts, but as long as you can keep your PCR at least at MMR 0.1% you should be able to wait. Maybe you should ask your doctor about a change to another TKI? Development of late effects TKI therapy is not uncommon. Let us know how you get on.

Sandy