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Hi Everyone,
Happy New Year!!!
My son latest PCR result is same like last time at 0.142. He is 1 Year into treatment with Dastanib and showed good response in the first 3 PCR results. He is only 20 years old so I'm really worried about him. He doesn't take healthy diet as a teenager. Got detected at the v young age of 19 years butshowedvgood response in the starting but now it showed the same reading like last one after4months of testing. It was 0.143 this time compared to 0.142 . Please advise.
Myra

Hi Myra,
Your. son is still very early in treatment.  It is not at all unusual for CML to plateau at levels well under 1.0, possibly more common in younger patients..  A CML reading less than 1.0 presents no real danger to the patient.  If your son remains plateaued for a year, or so, he may be able to gradually lower his dosage without it having an adverse effect on his CML level.   It's inadvisable for the onc to recommend a higher dosage in an attempt to push through the plateau as many seem to want to do; it presents unnecessary danger to the patient from increased TKI side-effects.  Again, at levels below 1.0 there is no real danger to the patient from the CML

Buzz

Thank you Buzz!

The doc wants to wait for the next test and if it doesn't go down she will try another tki.
He doesn't follow healthy diet and I think that maybe the reason or maybe resistance to this.
Please advise

Knowing that 0.142 presents no real danger from the CML, I would be hesitant to switch to another TKI unless it was at a much lower dosage, i.e. Sprycel 50mg.  All TKIs have side -effects.

Hoping your son is consistently taking his TKI and his CML level drifts lower.

Buzz

Myra, when you have time please post your son's CML history showing test dates and results.  I try to fully document case histories for future reference.  After being in a low level plateau (below 1.0), for a year, or so, it is typically safe to begin gradual dosage reduction, as CML seems impervious to gradual dosage increases, or reductions, or even changing TKIs.  Your son appears to be close to reaching this point in treatment.  Am I right in assuming his next test date is near the end of March, at which point his onc will decide, based on the result, whether, or not, to change his TKI.  His onc might be more willing to reduce his dosage when changing to another TKI if it comes down to this.  

at 0.143 there is no danger to the patient from the CML
0.143 is a very low CML level
when CML is plateaued at a very low level, for a period of time, generally, a year, or so, a very low TKI dosage will typically suppress it

Imatinib 399mg; Bosulif 300mg or Tasugna 400mg

Buzz

Hi Buzz,
My son had very good response with Dastanib in the first pcr test. The first 3 months value was just 1 percent then next one was 0.4 and then 0.14. He was in college and was not following a healthy life style. He tested in Dec and pcr is same like in August test.
Yes he will test in March end. Hopefully he is careful and follow a healthy routine and gets his pcr undetectable or further reduced to 0.001
I don't want to see and resistance or mutations.
Even changing tki is with more side effects. The Doc is not willing to reduce the dose of the medication. TFR is only after taking the full dose of TKI and only if you are undetectable for atleast 2 years is the criteria.
Hoping for the best,
Myra