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Low Counts?



My wife was diagnosed with CML in November 2019 and has been on dasatinib since.  Her counts have always been low, but recently her dr's office has suggested that a bone marrow biopsy might be needed, and we are trying to understand why (they have been vague as to why and the value of the test).

Here are some of her counts (they have  been around these levels since treatment started back in late 2019 / early 2020:

Neutrophils: .7

WBC: 1.5

Platelets: 103

RBC: 3.25


Her PCR hit a low of 0.07, but then went up to 0.09, 0.11 and is now at 0.1.  


Any thoughts as to why a bone marrow biopsy is needed and if there is anything that should be of concern based on her counts?

MartinZA who posted a similar question on here is in a similar position with all of a sudden low counts although as far as I know his BCR is still ok - your wife is no doubt having a 2nd biopsy because she has "lost" MMR albeit on the MMR line <0.1. Really there isnt much difference in reality between 0.07, 0.09, 0.1 and 0.11 with any of those BCR results. What is significant possibly is the "trend" up and the reason why we test regularly. TKIs are great but they are not 100% affective for all, all of the time. It'll no doubt mean monitoring the situation after the marrow sample shows no change and an increase in dosage or a possible switch of TKI if something is discovered. I dont think any of that is required we see on here time and time again trends up then a trend down lower than your lowest record prior.

CML is a bloody rollercoaster and not the rollercoaster that causes joy - we get moments of it - or at least I get temporary euphoria after each "good" test.

In short this is all just procedure and I am sure things will be ok - hard to operate with uncertainty but us CML'ers have to get comfortable with the unkown....

Sending you all best wishes. Keep us updated too.