Re: more on the management of myelosuppression

December 17, 2006

Hi all and in particular Cam and Shaylene,

Sorry I was away while this discussion took place. My usual email program is

not working and I am using Hotmail until I get it repaired. This means that

I don't have easy access to all my old emails. So bear with me.

In an L & L talk in 2003 (The Road Ahead: New Treatment Perspectives for CML

Patients) Dr, Druker had this to say about Nutropenia:

. If ANC (absolute neutrophil count) less than 1000, hold Gleevec

temporarily

. Allow counts to recover. then resume

. May consider G-CSF (Neupogen) or pegfilgastrim (Neulasta) so can stay

on Gleevec

. If ANC less than 500, at higher risk for infection

Given these guidelines, it only makes sense if the doctor that is treating

you has lots of experience with CML patients. An experienced CML doctor

would know immediately if you fall into the catecory of a patient who needs

a temporary rest from Gleevec or if you need G-CSF while continuing to stay

on Gleevec.

So my best advice is to seek out an experienced CML doctor. He can be a

haematologist or a hemo-onc. It doesn't matter. He must have experience in

treating CML and you might have to travel to see one. Reducing the dose to

200 mg is the action of an inexpeirenced doctor.

I am glad that you found this site.

Hoping to enroll you into the Zero Club in the near future,

Zavie

Zavie (age 68)

67 Shoreham Avenue

Ottawa, Canada, dxd AUG/99

INF OCT/99 to FEB/00, CHF

No meds FEB/00 to JAN/01

Gleevec since MAR/27/01 (400 mg)

CCR SEP/01. #102 in Zero Club

PCRU 5/02 at RVH (Questionable)

2.8 log reduction Sep/05

3.0 log reduction Jan/06

e-mail: zmiller@...

Tel: 613-726-1117

Fax: 309-296-0807

Cell: 613-202-0204

ID: zaviem

December 18, 2006

Hi Zavie,

I'm actually just writing to say hello and to add that the 1000 mark protocol is

what I've always heard from Dr. Druker though I know doctors get very nervous at

that point and want to take permanent drastic measures.

I had to chuckle (at your expense : ) because everything here seems to be

chaotic -- computers, televisions, radioes and especially cars. Christmas

shopping is very unpleasant but I braved it through today anyway. Kind of like

a BMB. Here at home the only thing electronic I can count on is my CD player.

Haven't caught up to the iPOD crowd yet.

Please take this in the spirit it's meant. There's a Grinch Colony down here

that needs to be run out of town!

Celebrate Gleevec and Sprycel and work towards a cure! Those are my sentiments!

Best,

RE: [ ] more on the management of myelosuppression