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Changes in Log results - Dasatinib

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Hi all,
Hope everyone is staying safe during these times. I have a question regarding the results of my recent, and would like other people’s inputs/experiences. In March 2020, I got a report of Log -4.9. However this month when I read my report, it produced a result of Log -3.8.

Both these results are, of course, considered MMR or higher, but for a sudden drop of 1 log point, makes me a little bit concerned.

Has anyone else experienced an event like this? Is there any major corner by regarding it?

 

Hi there,

A log increase is obviously not something you really want to see, but as you say you are still in MMR and therefore this is still an optimal response.

Are you going to have another test soon? It might be prudent to have another test soon instead of waiting 3 months to either confirm the increase, see it revert to previous, or potentially increased further (hopefully not).

David.

A one log change upward can be concerning. Ask your doctor for a re-test at one month instead of the normal three months testing interval in order to confirm your trend. It could be a testing "blip". What is your bcr-abl absolute level? What dasatinib dose are you taking and for how long?

Hi David, and Scuba,

I'm not sure what my absolute level is at (actually could you clarify what absolute level means in this term?). But the lowest I've achieved were the results of March 2020, Log - 4.9. I've been on 100 mg of Sprycel since diagnosis, December 2017. My progress was slower than most of the people I've seen here posting their results, but finally hit that Log last month.

During my checkup this morning, my doctor already assigned for another PCR to be done on Monday (since the lab doesn't work during the weekends), with results coming after 2 weeks or so. If it the results are the same, I'll be tested for possible mutations.

Looking back, I'm wondering whether my somewhat poor sleep schedule could play a factor in the sudden increase in my results?

Cheers!

PCR is typically reported as a percentage ..... PCR = 0.xx. If you are in MMR then your PCR would be below 0.1 %. Log reporting is always relative to starting PCR at diagnosis and is different for different patients. Whenever log reporting is the only result shown, it is assumed to be in comparison to PCR = 100%. So a 3 log reduction in PCR is equal to MMR which equates to PCR = 0.1% as defined by the profession.

My initial PCR was 155% (yes, I was in bad shape at diagnosis), so a 3 log reduction for my case equates to a PCR = 0.15, which is not MMR. But as David has pointed out elsewhere, these cutoff points (MMR, CMR, etc.) are somewhat arbitrary. These cutoffs just provide a milestone marker for doctors to judge against. I prefer absolute numbers not log ratios to interpret results. If I see a -4.5 log reduction, I have to assume the starting value of PCR was 100%. It's not a big difference in the scheme of things as PCR testing can vary greatly (one log up or down). I was just curious.

 

Understood, the next time I go see my oncologist I'll see if the lab that sends the results has these values written down (I'm sure they do). Since my diagnosis, all of the reports I've been given were the standard CBC/WBC. Of course every 3 months, I have the standard PCR done. I'm being treated in Taiwan, so the lab results are all sent to the larger hospital, then results sent via email to my doctor.

Just for clarity, are the values of Log-reduction based on each individual patient's initial diagnosis?

While I am concerned, today was not a very comforting day, I do feel confident that nothing ill-fated will come of this. Even before my diagnosis, I have not experienced any symptoms pertaining to CML. My diagnosis was completely blind luck, when I went to get my blood tested for another procedure I was going to have.

 

"Just for clarity, are the values of Log-reduction based on each individual patient's initial diagnosis?"  Should be.

You are going to be fine. Stay aware and track. Listen to your doctor and ask questions. New standards of care are emerging as the profession learns more.

You caught your CML in time (since you are MMR). Any fluctuations can be addressed. Focus on your overall health (heart, metabolic) and learn to use nutrition to enhance your immune system. CML is not going to get you.

Thanks Scuba,

From browsing through the forums, and other advices, I'm starting to take multivitamins, and then looking into finding a nutritionist who can help see what other deficiencies my body may have.

Thanks for the confidence boost!