One step forward, two steps back

There is no cure for CML. The only way to keep CML in “remission” is to take the medication – each and every day. I’ve learned this lesson first hand. I stopped Gleevec almost 9 weeks ago (a medication holiday). At the time of stopping I was in hematologic response, a complete cytogentic response, and a minor molecular response. This basically means that everything was going in the right direction.

The medication holiday has been good in that it has allowed my liver to recover. My liver enzymes are still high, but they have returned to within a tolerable range. I’m sure in the next few weeks the enzymes will totally normalize. That is the good news.

The bad news is the “holiday” has had the unintended consequence of allowing the cancer to restart the replication process. I lost the cytongentic response. The cytogentic test (called a FISH test) looks for the PH+ chromosome. The test examines 200 cells for the abnormality. Prior to the holiday, all 200 cells were clear of the leukemia. As of last week, 5 of the 200 cells tested positive. It could be worse, at diagnosis all 200 cells tested positive.

The molecular response has also changed. The PCR test looks at a large number of cells (100,000) for the BCR-Abl gene (the naughty product of the PH+ chromosome). At the start of the “holiday,” the amount of BCR-Abl genes positive was 0.834%. This has increased to 9.794% (again could be worse, at diagnosis it was in excess of 53%).

So, all of this means it is NOW time to restart medication therapy and quit this holiday! I should get the new medication – called Sprycel sometime next week. Tick tock.