Sandy,
My son Kevin is six and was diagnosed with CML in March.  After six months
on Gleevec (9/29/2008) he has achieved Complete Cytogenetic Response (CCR)
and his PCR is 0.022.  We're sticking with Gleevec.

You don't happen to live on Long Island, do you?  Your story sounds very
similar to ours: we were told Kevin would have a BMT from his 9/10 sibling
match, possibly in July-September, and in the end he would be just fine.
 Our second opinion said no way, stay on Gleevec.  We know a bio-chem
professor whose PhD classmates now work in cancer centers and top hospitals
around the country.  She did an informal survey and found the medical
community is disturbingly split on the treatment plan for pediatrics.  After
visiting the Seattle Cancer Center Alliance, who have done the most BMTs in
the country (Fred Hutchinson Cancer Center is now part of it), and Dr.
Druker in Oregon, we've decided to stay on Gleevec unless Gleevec and
related drugs stop working, or there's a cure.  Let's hope and pray for
that!

My wife Julie recently posted more details about all of this on the "Child
CML Talk" page:

http://www.newcmldrug.com/Children/reply.asp?ID=25073&Reply=25073

There are no simple rules for any of this, so I can't speak to your son's
case.  Plus I'm not a doctor, and no doctor we spoke to would make
recommendations without first examining our son.  In Kevin's case, a top
hospital said they would do a BMT if there was a 10/10 match.  Since there
is none, they recommend staying on Gleevec and doing a donor search every
2-3 years (I think).  Dr. Druker strongly recommends staying on Gleevec for
many reasons.

The fact that we're sticking with Gleevec for our six year old says it all.

The most important piece of advice I can give you is to get to a doctor who
believes in Gleevec, and knows how to monitor CML, and get on the correct
Gleevec dosage.  I've read many stories about people coming off Gleevec for
a short period of time because of side effects, then going back on it.  Some
have reduced their dosage.  Others have increased it for various reasons.
 In our case, Kevin was on too low a dose for months.  There is something
they call a "trough level test" that measures the amount of Gleevec in the
blood 24 hours after the last dose.  Kevin was 30% lower than recommended.
 We increased his dose, repeated the test weeks later, and now it's at the
right level.

Our first doctor was planning for a BMT and felt the trough level test was
unimportant.  We strongly disagreed with both of those ideas.  We used to do
all the research and tell our doctor what we found, and he would need to be
convinced to make changes or perform tests.  Now we're with a doctor who
believes Gleevec is the way to go.  He knows more than we do about treatment
with Gleevec, which is a nice change.

If you decide to stay with Gleevec, make sure you have the right doctor.

I know how confused and overwhelmed we were (are?).  It's a little better
now.  We're seven months into this.  If you'd like to speak with my wife or
me, let me know.

Here are some links for you:

Dr. Druker lead the creation of Gleevec and spoke on the TV telethon "Stand
Up to Cancer" in early September 2008:
http://www.youtube.com/watch?v=JIK_tL2LClw

Technical 1 minute explanation of Gleevec:
http://www.youtube.com/watch?v=iaK99RxEyAU&feature=related

24 seconds with no sound.  BCR-ABL is the mutation that makes a white blood
cell a CML cell.  ATP is key to the energy cycle of the cell, and when the
substrate detaches it enables cell growth and division.  Gleevec blocks that
process:
 http://www.youtube.com/watch?v=nP8-9WWp5ZQ&feature=related

Really good visual with an explanation in a language from another galaxy
with some words that you could swear were English:
 http://www.youtube.com/watch?v=QR6d2cfImRc&feature=related

This transcript, 22 pages, is from a telephone education program of the LLS,
with Dr. Druker (there's an MP3 audio as well).  Dr. Druker explains the
data available on Gleevec.  I have no references to put here, but I believe
the data on BMT are more risky than Gleevec:
http://www.leukemia-lymphoma.org/graphics/National/EI2546BT6CMLTranscript.pdf

Regards,
John

On Mon, Nov 3, 2008 at 11:04 AM, SandyC <[EMAIL PROTECTED]> wrote:

>
> Hello,
> My 13 yr old son was diagnosed with CML in August. He is currently
> being treated with Gleevec and responding very well. No major side
> effects besides headaches, stomach pain and fatigue. We were
> originally told that the only treatment option is Gleevec and BMT. We
> met with another Dr and she recomends leaving him on Gleevec...no BMT.
> So, now we have a major decision to make! Who is right? What is the
> best treatment plan? There is very little info for pediatric CML out
> there. Anyone have any opinions?? I am so confused...how could there
> be such a huge difference in opinion?
> Any feedback would be greatly appreciated!!!
> Thanks,
> Sandy
>
> >
>

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