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Question , please advice


Hello , 

As a background story which are in my other threads , about my sister ( 21yrs)  who was diagnosed in June,2018 with CML and had a resistance to imatinib after we switched to nilotinib.

her BCR-ABL in November 2019 was : 0,13%

And now her BCR-ABL grew a little to : 0,3%

is this normal ? Should we jongle with other Tki’s or remain normally on Nilotinib ? 

a good opinion will help me . Thanks

A little background regarding the resistance to Imatinib would be helpful. Did her numbers climb in two consecutive tests significantly? Was mutation testing performed?

I think that the established method is to observe two consecutive tests with climbing numbers and then perform mutation testing to decide on next TKI.

Imatinib attacks the disease very similarly to Nilotinib. Perhaps Dasatinib would have been a good choice. Again hard to say without knowing the approach taken to switch to Nilotinib.

I would add that 0.5 is within lab error believe it or not so she may be back down and lower in her next lab.

I, like most on forum, am no doc but read up quite a bit because I am a turtle in responding as well. The good news is that she is responding and tolerating the meds from what I can tell.

Yes , at the beginning she had  began her treatment with Imatinib but she lowed to 20% not in a fast way how it shoulded be doc says , after she reached 20% from this point Imatinib didn’t help to go under this percentage and began to jongle between  24% - 22% .

they did a mutation test and they found out the TP53 mutation but they told us this mutation is common in CML and we don’t have to worry about .