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Plasma Level monitoring

Forum readers, Re my recent post on BCRABL/ABL % ratio and plasma testing, and Kenny's post re PCR test results, I just wanted to provide feedback for the Forum on the plasma test I had some while ago and the resultant action and follow up.

Based on the info I provided, from the post under newswire, my consultant contacted Novartis for plasma test packaging and blood plasma sent off to Bordeaux. Results back in about 3 weeks. The imatinib drug level just before taking the daily dose ( about 24 hours after the last dose) was 511 nano grams per ml, which is only about 1/2 of the ideal level. My drug dose was upped to 600mgs and fortunately I've experienced not too many side effeects. ( rather tirder and some diarrhoea). I've just had latest BCRABL/ABL % ratio back, and I'm glad to say that my increasing % readings have been halted by the higher dose. Readings since diagnosis have gone 56%( month before starting imatinib), 7.8%,0.139%, 0.208%, 0.431%, and then latest 0.073% - good news. A further plasma test had been done at same time and result on this was still on low side at 817ngms/ml. However given PCR ratio consultant is happy with 600 mgs dose,
All of this may help those others who are trying to convince sometimes reluctant consultants to carry out free plasma test and send to Bordeaux!! I certainly feel more informed about the drugs effect in me, as a guide to treatment direction, so a big thanks to Sandy for all your very useful newswire posts.
Andy

Congratulations Andy, I am so pleased to see that your PCR has dropped on 600mg. It worked very quickly for you too!

It is also good that you do not have too many side effects.

Enjoy the summer - you can relax a whole lot more now.

Regards, Janet

Dear Andy,
This is such good news. I am so pleased for you. Your example will really be of benefit to those who are currently experiencing either sub-optimal responses or intolerable side effects to imatinib. If a plasma level of 817 ng/ml can reduce your pcr so much then it proves the point.
I am glad that 600mg has not affected you too much.... you mention you have some diarrhoea, it may be worth thinking about dividing the dose... 300mg twice daily- see Phil's post below about this.... which may combat this effect and may help raise your plasma level even further?
I am sure your consultant will be grateful to you for alerting him to this project run by the Bordeaux team/Novartis.
I also hope that very soon the plasma trough (lowest point) level tests will be routinely available at all CML specialist clinics, as this would also help those on the second generation TKI's, dasatinib and nilotinib.
Thank you so much for posting your results here. I cannot tell you how pleased I am... it makes everything worthwhile.

best wishes,
Sandy

Hi Andy

That's great news for you and some excellent ammunition for those of us who really would like to have the test done, to see if an increased dose would help, before being taken off Glivec.

I think I might well print your comments off and take them with me, when I next see my 'reluctant' consultant.

Thanks for sharing it with us!

All the best
Chris