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Meaning of the test?

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Hello friends,

My boyfriend was diagnosed in May 2018 with CML, PH 100%, Bcr abl P210 positive. He is on imatinib 400. He has got his 6 months blood test as following:

Ph: negative

q BCR- ABL p210: negative ( which was positive 3 months ago). The test do not show the percentage like the pcr test people often talk about in this forum.

can anyone help me understand the meaning of the test. I can not wait till the day he is going to see his doctor (2 weeks from now)

the BCR - ABL p190: also negative in the 3 month test

Thank you so much!

 

It may well be a FISH test, rather than PCR. 

https://www.cmlsupport.org.uk/sites/default/files/qrt-pcr-primer.pdf

Have a read of our primer at the link above. Read up to page 8 and it'll describe CML testing and what a FISH test is. A negative result of a FISH test doesn't equate to a negative PCR, by the way. 

David. 

Thank you for sharing this link Mr David. Next time we will ask the doctor about FISH and PCR. We live in Viet Nam, a country in south east Asia.I find it hard to understand why the doctor did not use PCR test. Every test only showed negative/positive

 

I love Vietnam. I've been lucky enough to visit a couple of times - one of my very favourite places.

I may be wrong, but this is my guess as to what is happening:

PCR tests are excellent at identifying CML in tiny amounts. It can see the needle in the haystack. It's not so useful when there is lots of CML in the body. 

FISH is good when the is lots of CML. So it's very useful in the months after diagnosis, but usually not so useful in the long term. 

I studied the doctor wants to see a negative FISH result, which would indicate the medication is working, before moving to PCR tests. A negative FISH test usually equates to (about) a 1% PCR at the highest. 

Why isn't the doctor ordering the PCR test earlier? They are more expensive, so may wait to use PCR until it is the most useful testing tool.

This is just all speculation. 

David

Hi David

So lovely to hear your thought about VietNam I wish to have a chance to see you in my country. 

Your writing did help me understand more, and I think it makes sense as my boyfriend has been on treatment only 6 months.(although we hope the test is PCR negative, but in that case it is one in a million, isn't it?)

I will update more after seeing his doctor on Jan 17th

Thank you so much for all the infomation and support.

Phuong,

 

 

It would be very surprising, but not totally impossible, if his PCR test was negative. Most of us, many years later, still have positive PCR tests with low levels and that is absolutely fine.

The quality of the lab performing the PCR test also factors in to the result of the test. One lab that is not so good might report a blood sample as negative, whereas a high quality lab may be able to see very low levels of CML.

David.

Hi David, how are you?

We met the doctor last week and asked him about the test, we also brought the document shows the levels of molecular respond (EMR, MMR, MMR 4.5). He said the test is better than all of those, negative means the BCR ABR P210 is undetectable. We were so happy although we could not ask anything more because he was a little bit unfriendly :(

Is it true that the such early respond ( at 6 months) usually goes with long term respond to Imatinib? We hope my boyfriend will not have to change to other TKI. In Viet Nam, only Imatinib and Nilotinib are available. My boyfriend is now doing fine, blast is zero, the spleen turned nomal size. He just has to fight with his fatigue and a bit low red blood counts.

 

 

 

 

 

Hello Phuong,

Your boyfriend's doctor should be very happy that his patient is doing so well!  Maybe he was having a bad day.

An early and deep response is the best result you can hope for.  It is usually a sign of long term CML control and possibly even a cure.  If the results continue to be undetected for a few years, treatment free remission might be in the future.

I think it's a good idea to get a copy of the BCR-ABL1 report for your records.  Sometimes the sensitivity of the PCR test is mentioned on the report.

Congratulations,

Kirk

That is an unusually quick response, but of course not impossible. It sounds like he is definitely doing well.

But before you run a victory lap, there are a couple of things to remember. Undetectable doesn't mean gone. It just means the lab can't see the disease. Some labs are better than others - some very very good labs can see almost 1 cell in a million. Others only 1 in 10,000. 

So what I am saying is that this sounds like good news, but your boyfriend must continue to take his medication.

David.

Thank you so much Kirt. We have already had the copy of the BCR ABL report. We will continue to save and track the number now and then. 

Hi David, 

I got it,  My boyfriend is continuing to take 400mg Imatinib per day. Thank you for your informative advices. I am really appreciated. As my boyfriend will have the long jouney with CML so the support from you and the forum community means alot to us!

 

Possibly his test is just a PCR( RT-PCR ) test, not a quantitative one.

If this is the case, still negative is good news.

My mother's history

@Dx      qRT-PCR : %54,61      FİSH : %41   ( Fish test also gives percentages but its accuracy is awful )

@3rd     qRT-PCR : -                 FİSH : % 0     ( Our hospital has no PCR kit so they just did FİSH )

@6th     qRT-PCR : -                 RT-PCR : P190 Negative

                                                                  P210 Positive

* They still didnt have the kits for PCR Test, so i went to another hospital and ask them if they are using PCR test. They say yes but as you see it was just a RT-PCR test.

@9th     qRT-PCR : %1,08

...

Her Report

https://imgur.com/a/ARE9abw