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Pleural Effusion/Rash

I have a question living here in the US in GA. I haven't posted in a while but when I went to see my Dr he said I have a mild case of pleural effusion. I've had it for over a month now. I've had CML for 22 years. Started on Gleevec for 9 years came out of remission went on 100mg of Sprycel. Now on 40mg for 2 years Dr doesn't want to cut it to 20mg. (didn't want to cut it to 40 but I insisted) My last BCR test was 0.000. Had a echocardiogram to look at my heart.. it came back normal. Everything is good except for mild PE and a rash on my back. My DR said when Sprycel causes PE it is usually severe. Can Sprycel cause mild PE and should I be concerned with mild PE. Wondering if it is the Sprycel. Would cutting to 20mg take care of this. Has anyone had mild PE from Sprycel and if so what did you do? Also concerned about the rash on my back and legs.

By the way this site has been extremely helpful for 22 years. I am probably one of the first to go on Gleevec... 22 years later alive and doing well.

Tom

Tom, yes, Sprycel can cause a mild pleural effusion. Typically a full blown pleural effusion is treated by stopping the TKI until the pleural effusion resolves. A mild pleural effusion could be treated with a lower Sprycel dosage, if treated at all.

Lowering your Sprycel dosage will lessen the probability of pleural effusion; lowering your Sprycel dosage will also lessen the probability of a Sprycel induced rash, if your rash is being caused by Sprycel..

You mentioned that your last PCR test, after being on Sprycel 40mg for two years, showed undetected. What were the results of your previous PCR tests while on Sprycel 40mg? It would be preferable for you to be undetected for a period of a year, or so, before reducing your dosage. There are exceptions to that rule. You have been on a TKI for an exceedingly long period of time; likely unnecessarily on full dosage for almost the entire time.

If you think you are ready to reduce your Sprycel dosage you might attempt to do so gradually; alternating Sprycel 40mg and Sprycel 20mg would equate to an average of Sprycel 30mg. Taking Sprycel 40mg for three days and Sprycel 20mg on the fourth day would equate to an average of Sprycel 35MG.

When do you test again?

Wishing you well,
Buzz

Buzz, thank you for reply. I hadn't thought about lowering the dose to 30mg to get rid of the mild PE and the rash.

Thank you,

Tom

There are many of us, me included, who are on 20mg of dasatinib. Can’t you just insist that you give that a go, and agree to slightly more frequent PCR testing to monitor?

David.