Re: Re: testing for MRD after FCR

[Guest guest]

Dear Dr Furman,

This is just what my local onc says "how will knowing change anything?". Only that knowing would make me VERY HAPPY & give me peace of mind!! But I suppose I could repeat the Flow every six months or so, instead?

Which is a more effective test on the BM, a Flow or a PCR? Can PCR be done on the blood?

Thank you!

Marcia

ps-nodes & spleen "gone" & labs normal, except for slightly low platelets still.

Re: testing for MRD after FCR

Marcia,The real question is what is the utility of obtaining the information? In other words, how will knowing your bone marrow status change how you are treated? Often, when not in a clinical trial, there is no reason to do bone marrow biopsy or even a CT scan after completing therapy. If one were to plan to do something else, such as consolidation with alemtuzumab, etc., then knowing the status might be helpful.But there are also two different methodologies for assessing status. The classical one is "hematologic". This is done by looking at the CBC using a standard CBC and looking at the lymphocyte count, platelet count, and hemoglobin; performing a physical exam for palpable lymph nodes and hepatosplenomegaly; and a bone marrow biopsy and looking for CLL nodules in the marrow.The second is what we call "MRD", or minimal residual disease. This is done by using more sensitive methodology, naming flow cytometry, to determine whether there are any CLL cells circulating in the blood or bone marrow.Both of the methods are powerful means for predicting time to relapse, but what must be remember is that if there is going to be nothing done differently based upon the information, why do the tests? While these tests could predict the median time to relapse for a group with the same extent of disease, they cannot tell you when you will relapse. You are still waiting.This may change in the future, once we learn more about using other agents as consolidation or maintenance therapy, etc.Rick Furman, MD>> Dear Dr Furman,> I finished 6 cycles of FCR a little less than 4 weeks ago. I've always assumed that I'd have a BMB sometime afterwards in hopes of finding out that I have the desired PCR neg result. Or not... My local onc, who is associated with Stanford, says Stanford does not do BMB after FCR & only does a Flow on the blood, which is his preference as well. But this is not at all as thorough a test, is it? We did one this past week, simply because I could get some labs done for "free", having met my deductible. But three weeks after the last FCR, couldn't there still be some circulating cells? I'm still torn about having the BMB. Could you discuss which post-chemo test is the most accurate, and what is the desired time frame to have it done? > As always, your responses are so much appreciated.> Thank you,> Marcia in CA dx'd 2000 FCR 2009>