Hi , can anybody help and explain about PCR results to my husband and I ?
Try as we do we still find it a challenge to understad them.He was diagnosed in Nov 2010 and went onto imatinib 400mg per day. In Oct 2011 when he had another bone marrow biopsy he was told his PCR had more than doubled and so he needed to be referred to HH. (We thought it might be connected to an eye infection he had had and was given 3 lots of antibiotics including ones that were put directly into the eye in a liquid form, the other two were creams). We were told this would not have caused the increase and so we went to HH for further investigation.At HH they too were unable to explain and suggested it could just be a blib or maybe he is just a slow responder.As he has very few side effects he decided to stick with the imatinb and wait and see how things panned out. We keep on being told he has not reached these ' magic targets' which is rather worrying and there has been a suggestion of doing a trial or changing to another TKI. Its hard to know what to do for the best so for the time being he is sticking with the imatinib because the PCR is going down,all be it slowly.Does anyone have any advice? He has another appt next Mon 18th June. PCR counts were as follows:
Nov 2010 - 99.892
March 2011- 28.643
June 2011- 8.994
Aug 2011 - 4.980
Oct 2011 13.258
Nov 2011- 6.413
Dec 2011- 4.170
March 2012 - 3.067
April 2012 - 2.631
Should he change to another TKI or stick with the imatinib?
Thanks very much
Mary
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PCR Results
Dear Mary,
It look like he has a sub-optimal response as he is taking so long to get to the required low molecular levels ...a 3 log reduction from diagnosis.
As your husband has taken a full 12 months to get a drop of only 25% from
28.6.. in March 2011 to 3.06.. March 2012- and he still has not reached CCyR - less than 1.5%- which is the first major target his doctors would have wanted to see within the first 12 months, then it might be better to change to a 2nd generation TKI, probably at this moment it would be nilotinib, which is NICE recommended for both 1st and 2nd line.
Have a talk with his doctor about what is available and take advice from HH.
In my opinion- he needs to change to another TKI to get him into a deeper molecular response... pref. 3 log reduction or 0.1% in the international scale (MMR) which is a safe haven for most people in the longer term.
Best wishes,
Sandy
Sandy,
Thank-you for the advice ,we will talk to Dr at our local hospital at next appt on Mon 18th June. Appt at HH is not until 16th July ,do you think we should wait until then or try and get earlier appt? Its all a bit of a vicious circle and now Im thinking will HE even get holiday insurance if he changes drug just before we go to Greece on 21st July. Im still trying to find cover ands thats with taking the imatinib and 18 months down the line!!! This damm CML seems to dictate life even though he feels reasonably well.
Regards
Mary