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TFR question

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My Doctor wants me to try TFR next year.

Diagnosed in August 2018.
Reached MMR in 9 months on sprycel 100mgs.

For the last year I have been in a 4 log reduction while being on 80 mgs of sprycel.

9/2024- .0035 %
11/2024- <.003 % ( test cannot detect anything less than .003)
1/2025- .007%
3/2025- .0058%
5/2025- <.003%

My question is do I stay at 80 mg and try TFR next May. Or do knock my medication down to 50mg and eventually 20 mg before I try TFR. My doctor is willing go down in dosage but also said since maybe I stay on 80 since its working and I have little side effects.

Hi,

Every time someone asks a question like this I suggest looking at this video; it is getting a little old now, and its main focus is on imatinib patients, but I hope it is useful. https://cmlsupport.org.uk/videos/reducing-or-stopping-treatment-who-and-...

Thanks ill take a look

I just came off a TFR attempt in the last year and found that the type of transcript you have, e13a2 or e14a2, can be a deciding factor in the sustainability of remaining in TFR.

JP

I am not sure how to fin out if i am either of those. I dont remeber seeing that info on my FISH.

You will only see different transripts identified on a BCR-ABL test. FISH can't differentiate down to a microbiology level. The results you quoted above are from a BCR-ABL test.I you have the full report on those results it should list the transcripts they found.

Just look for e13a2 or e14a2 on your PCR report. For years I never paid attention to them.

My last report said this

p210 Value (BCR-ABL): Your value is Positive. p210 BCR-ABL1 fusion transcripts detected.

International Scale <0.0030

Method:
Xpert BCR-ABL1 Ultra utilizes real-time reverse transcription polymerase chain reaction (RT-qPCR) to quantify BCR-ABL1 p210 fusion transcripts e13a2 and e14a2 (also known as b2a2 and b3a2, respectively) with the upper and lower limits of quantification being 55% and 0.0030% (IS), respectively.

I found this:
The p210 and p190 in the context of BCR-ABL1 refer to different protein isoforms produced by the fusion of the BCR and ABL genes. The e13a2 and e14a2 transcripts are associated with the p210 isoform, commonly found in Chronic Myeloid Leukemia (CML), while the p190 isoform is more frequently seen in Philadelphia chromosome-positive Acute Lymphoblastic Leukemia (Ph+ ALL).

On my reports there are results for the two transcripts. For me e13a2 is >.003 while e14a2 is <.003.

Joe

Interesting. Maybe the lab that my Doc uses just does not show my those details. Maybe he can see it on his end.