Please see below for some notes covering two topics covered at our last patients' group. Pennie and myself thought the notes might be of wider interest to the Forum
Regards
Andy
Meeting CML Patient support group Kings College Hospital
Wednesday 29th September
Dr Nicholas Lea Health Care Scientist Molecular Haemato- Oncology and Tris Kontou Senior Clinical Scientist speaking on cytogenic and blood tests for CML
Tris was the first speaker and outlined her work relating to cytogenic testing of Bone Marrow Cells and FISH testing of blood samples from patients with CML..
Cytogenic testing - around 20 cells examined under microscope and check made to see how many of these carry the fused chromosomes 9 and 22 . The process also indicates whether other clonal abnormalities are present. The results inform both dosage and treatment plans for patients .
FISH testing actually looks for fused genes BCR/ABL which creates the protein which in turn drives the leukemia . Fused genes can be seen by staining cells with appropriate staining media,
These two tests can track reductions in leukemic cell load down to about 2 log reduction (about 100 fold reduction) from the start point.
Nicholas spoke on PCR testing. This can track down to a 5 log reduction (about 100, 000 fold) . Like FISH testing, the test looks for BCR/ABL genes contained within DNA
Nicholas outlined the process for testing . Firstly white cells are separated out of the sample, and a substance related to DNA is isolated. This substance is messenger RNA. This is then purified and stabilized via a chemical process and a substance named cDNA isolated . This then goes to the last stage of the process where the samples are placed in a machine that heats and cools the sample through about 50 cycles, with each heating and cooling process concentrating the BCR/ABL marker . Monitoring and interpretation the sample is done by shining a laser beam through the sample. If BCR/ABL is present in sufficient quantities then at some point in the testing the reading rises very rapidly between testing cycles and this increase can be mapped against standard readings where the percentage of BCR/ABL cells is known. The rapid rise occurs sooner with samples containing higher amounts of the BCR/ABL gene, than lower amounts.
About 2 or 3 runs of the machine are carried out per week, processing samples from around 120 patients. The accuracy of the process is not so good at low levels , say around the 4 log to 5 log reduction zone. Like many Labs working in this area Kings are standardizing their results against an international standard
Sometimes samples fail because the sample has taken too long to arrive at the Lab or flaws occur in the testing procedure. All testing is monitored to make sure that results that are produced do conform to an acceptable level of accuracy.
Nicola Gingell speaking on the role of exercise in CML therapy.
Nicola explained there are many benefits to exercise including lowering blood pressure, improves bone density, management of weight, preventing or controlling diabetes, prevention of some cancers.
The ideal was for 5 sessions a week of up to 30 minutes. Bur this could include all types of physical activity e.g. gardening, walking the dog, housework as well as activities such as walking , swimming and cycling.
The exercise should enable the person to still speak a full sentence but not talk non stop !
She appreciated that patients undergoing any form of cancer therapy tended to feel fatigued but there was a danger of a cycle of inactivity starting where gradually fitness deteriorated . Those patients who had received a bone marrow transplant would definitely feel very fatigued but the current view was that even these patients should be encouraged to take limited exercise, under supervision form a Physio, asap after the transplant. Glivec was also known to produce fatigue in patients in up to 30 % of patients. However moderate exercise could reduce fatigue.
The key approach was to start gradually and build up the exercise . You should not feel adverse effects from exercise the next day, if the level of exercise was correct.
Nicola mentioned the FITT principle
Frequency of exercise
Intensity of exercise
Time of exercise in terms of length of session.
Type to ensure different muscle groups are worked.
Exercise was not recommended where blood counts were low ( below (8.5) red blood cell and below (20) platelets) and care should be taken with exercises like swimming in public pools where infection risk is high and white blood cells are low in the patient
No pain should be experienced and do not exercise if you have a temperature or infection.
