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Secondary chromosomal change in a Ph+ cell

Hello everybody


Just wanted to ask if anyone had any experience with secondary chromosomal changes (i.e. additional chromosomal aberrations) in Ph+ cell.

During my 3 month bone marrow aspiration, they discovered a new translocation t(8;21). It was not the AML marker, just an atypical translocation in my leukemic cells. We do not know whether it was present at diagnosis since karyotyping failed but my hematologist has the feeling that it may have been since it was seen in all Ph+ metaphases (indicating one single and prevalent clone). Still, she was a bit worried and of course, so am I.

I've read a lot of studies and there is some very conflicting data on it. Some say, that a limited number of additional changes affect outcome and confer a worse prognosis but many of those changes do not affect at all. ELN guidelines state that only in the case of a high-risk ACA, a patient should be considered as a high-risk patient, the same goes for NCCN guidelines. So, I am quite unsure how to process this aspect of my disease, somehow I have the feeling that it puts me in a higher risk category, although my different risk scores were low to intermediate.

My response was 16 % (baseline 80 %) at 3 months and 11 % at 4 months on imatinib. I was switched to nilotinib due to myelosupression and continuing it on a lower than standard dose. 6 month PCR is due in mid June.




Timo - I can't find the study now (I tried) but I read one that said t(x,22) was not a high risk. From everything I read 3, and 17 were a couple that should signal a change in approach. Also keep in mind that some of these studies were done only on Imatinib. The one below includes second generation TKI.

Most patients know very early that it is not working and don't get past CHR if that. You are responding and hoefully come June it will be close to 1.0 or lower. Hope that helps.

Thank you!

I've read that study as well. Well, we will see if it has any negative effect on treatment. It's just that it is an unknown variable in my treatment process and makes me wonder all kind of things, including associating my response rate and myelosupression with it.  =)