Hello my name is Donna. My 79 year old mother was diagnosed with CML in early acclerated phase. She went in for her yearly physical in December and her platelets were high. She was not having any symptoms. Her GP referred her to an oncologist/hematologist and was diagnosed in Mid January. Her platelets were at 1,000 at the start of treatment. After 10 days on medication her labs were checked and platelets went down to 600. We did not have the blood results right away of the BCR-Abl on this day because dr said it would take a week. We were very encouraged that her platelets went down and the Dr told her to come back in two weeks which was this past Friday. At this visit, the blood work for the BCR Abl that was taken at the last was in and it showed that the medication was working. I don’t know what the numbers were but it was positive. They did the same blood work up on Friday and the her wbc, hematocrit, hemoglobin were now low and her platelets were now 81. My initial thought was that the sprycel dosage needed to be lowered which I guess is a possibility but the Dr didn’t want to incase there is a chance that she has entered into an acute phase. We won’t know the results of the bcr/abl test for a week. If the test shows she is still responding then the dr would adjust the medicine. The blood work showed a positive response the last time it was tested. She told her to continue taking the sprycel at 140 dose and wants to see her back on Tuesday to check her labs again and maybe do a bone marrow biopsy again. I am worried that if the sprycel is too strong that she will get weaker and also worried that it could be in acute phase now. Her lab work at time of diagnosis was high platelets all other functions were normal. She seems to be tolerating the sprycel ok. Has anyone ever had to lower their dose because it was lowering wbc, hematocrit and hemoglobin? I wish we didn’t have to wait so long for BCR/abl lab work. Any thoughts would be appreciated. Thank you.
You are here
Does sprycel dose need adjusting
You are correct in being concerned. Sprycel is a potent TKI and can often times result in severe myelosuppression (low blood counts). You need to be vigilant and watch blood counts closely - at least weekly - Neutrophils and platelets, in particular.
Patients your mother's age can do very well on very low dose sprycel (< 50 mg). If her myelosuppression continues, she should INSIST that her drug dose be lowered - even temporarily halted to allow for blood cell recovery.
Search this forum for sprycel and myelosuppression, you should see much discussion on this topic.
(I was diagnosed in accelerated phase and suffered severe myelosuppression on sprycel 70 mg. I had several dose interruptions and eventually stabilized at 20 mg sprycel and am now "undetected" for near 3 years.)
Thank you for your response. I think the 140 dose was prescribed because she wasn’t in the chronic phase but rather accelerated phase. Is the 50mg dose for chronic phase? When her numbers had gone down so much my gut was telling me that the sprycel needed to be lowered. I was shocked when the Dr mentioned that she could have advanced to the blastic phase. I had not even considered that. Dr said anything is possible with this disease so she didn’t want to rule it out.
What were her initial blood counts at diagnosis? blast cell count, in particular?
(Your mom should have her vitamin D level tested and if low, she should supplement with D3 to raise it to be above 50 ng/ml. I maintain mine around 70 ng/ml. Vitamin D activates our immune system and assists blood cell differentiation from blast cells to daughter functioning cells - including leukemic ones).
I don’t know her blast cell count at time of diagnosis. I do know that her platelets count was 1,000 but all other labs were in normal range. Thank you so much for all your information. I really appreciate it. I am also happy to hear that you are doing well.