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Stay course or try Sprycel dose reduction


Could use some reassurance and thoughts.

Diagnosed November 2016. Currently on Sprycel 100mg. Stalled out before on Imatinib and Bosutinib gave liver problems.

MMR Finally April 2019.

April 2019 - .08

June -  .05

September - .03

January - .04

First time I‘ve not had a reduction since finally reaching MMR. Wondering if I‘ve plateaued and will not reach Deep Molecular Remission. 

At last appointment we discussed doing a dosage reduction. Not sure my Hematologist will agree to try reducing dosage with the latest result. Appointment this week. Would you push to try reducing dosage or just stay the course given last few results?


There is some thinking that less is more with Sprycel.  You are at a very safe place after not an unusual span of time getting there.  There are studies showing that 50 mg of Sprycel - as a starting dose - is as effective as the higher dose.  In my opinion, it would be safe to try and see what happens by reducing to 70 or 50 mg.  ANECDOTALLY, each time I REDUCED my Sprycel my PCR responded DOWNWARD.  This is possibly having to do with Sprycel's immunosuppressive effects - in other words, less Sprycel allows more of your own immune system's soldiers to fight the CML. I believe, however, that this kicks in more after people have been on it for a good while and have extremely good control of the CML (which is your situation). The most important factor in your decision should be - what is your goal?  If it's to mitigate bothersome side effects or future side effects (pleural effusion, say), then a reduction should be amenable to the onc.  If it's to hurry up and reach undetectable and then TFR, he's going to balk.

Thank you Kat!

My goal is to hopefully reduce future side effects such as the pleural effusion. I am not so concerned about TFR. If I get there, I get there, but that has never been my main goal.

We will see what my Oncologist says. She is quite experienced with CML, but definitely likes to be conservative in her treatment plan.