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BCR Elevated from .09 to .18 after treatment stop



My wife has been taking Sprycel 70mg for about two years now and finally hit MMR (0.09) about 2 months ago.  However, her neutrophils dropped to .4 about 5 weeks later and she had to stop taking Sprycel for 7 days, which was right up to the her next PCR test.  

The test results from her later PCR test were 0.18. She is very upset and worried about the raised BCR. I suspect this occurred due to the treatment stop, but wanted to hear if anyone else has experienced something similar.   

She is back on Sprycel 70mg and will have another PCR in a couple months.   

I think it is a safe assumption to say that it is probably because of the treatment stop.  I would add that 0.09 to 0.18 should not be cause for alarm because she wasn't taking the TKI.  I would search other threads regarding low dose 20mg or 50mg to deal with low neutrophils.  I don't think there is any reason to think that the BCR will not drop once taking TKI consistently but I would investigate low dose for dealing with low counts.  There are several threads about the subject and people that had to deal with that and are doing quite well.

I had a very similar issue involving neutrophil suppression at 70 mg sprycel (dasatinib). I was taken off treatment until my counts recovered. Then restarted, then had to stop to allow counts to recover and then ultimately stabilized.*

What my doctor did after stopping me the first time is what I suggest your wife consider. He restarted me on 20 mg dasatinib. His research showed  lower dose would work better than the higher dose when suppression was occurring. In other words, your wife is likely to have a better response on 20 mg than 70 mg and with less myelosuppression. This is what happened to me. Once on 20 mg, my CML fell back and then plummeted to very low levels and ultimately undetected. I remained at 20 mg for several years but now I am now drug free for over six months with no loss of remission (yet). I have a suspicion your wife could follow a similar path.

(*interestingly my CML levels did not rise much while I was off treatment for about 3 months at that time. But I was by then taking 8 grams of Curcumin per day as well as increasing my vitamin D levels. Your wife can benefit from doing every thing she can to improve her immune health as her CML stabilizes. And it will stabilize and then plummet)

I would also like to add that the difference in her test results is so miniscule - statistically insignificant - not worrisome at all.  I have experienced what Scuba described - after a short break off drug, a much deeper response upon starting it up again --- and at a lower dose of Sprycel.  I have not seen any studies to corroborate or explain this, but anecdotally it seems to be often the case.  Lastly, don't worry TOO much about a low ANC. All these blood counts can be low for years - mine still are on the low side of normal after 12 years! You only really need to hang onto a 1.0 ANC.  I know it doesn't feel like it, but it's still early days for her.  Keep going on Sprycel! 

Thank you all for the feedback, this is very helpful and reassuring.  My wife would prefer to be on a lower dose, hopefully that can happen soon. 70mg has been rough.  

The fact that 70 mg has been rough is all more the reason her dose should be lowered. She is very sensitive to Sprycel and lower dose is best if lower dose works. The lower the better in fact.