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Molecular monitoring

  • Udani sajitha Kothalawala
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1 week 4 days ago - 1 week 4 days ago #2094 by Udani sajitha Kothalawala
Molecular monitoring was created by Udani sajitha Kothalawala
Hello,

Recently we have come across a patient with both p210 and p190 transcripts at diagnosis.

What is your experience with a case like this and its molecular monitoring and management considerations?

Awaiting your reply.

Best regards - Udani (Registrar in Haematology, Sri Lanka)
Last edit: 1 week 4 days ago by arlene.
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  • Gianantonio Rosti
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1 week 4 days ago - 1 week 3 days ago #2095 by Gianantonio Rosti
Replied by Gianantonio Rosti on topic Molecular monitoring
"Both p210 and p190" in which %? Generally, p210 is predominant (1-2% of all CP patients may exhibit this association). However, there are data supporting a worse prognosis for patients bearing the association. Generally, those who progress do so in the early days.

I understand you do qualitative RT QPCR at diagnosis due to financial pressures of many patients, but it’s important to follow-up with quantitative monitoring of the highest burden. It is important to know at diagnosis if p190 is a small fraction or the highest burden. Generally, it is a small fraction and disappears rapidly. If prevalent, this notion has relevant prognostic features with p190 bearing a worse prognostic meaning vs p210.

To be practical, in terms of management, there is no strong data in favour of second gen TKIs vs imatinib. Monitoring is as per p210 only patient.
Last edit: 1 week 3 days ago by arlene.
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  • Jerry Radich
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1 week 3 days ago #2096 by Jerry Radich
Replied by Jerry Radich on topic Molecular monitoring
What are the levels of each transcript type? It is often common for cases of p210 disease to have very low levels of the p190 transcript at diagnosis, and this is believed to be a splicing event with no impact on prognosis.
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  • Beppe Saglio
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1 week 2 days ago - 1 week 2 days ago #2097 by Beppe Saglio
Replied by Beppe Saglio on topic Molecular monitoring
The P190 transcripts derive from alternative splicing and therefore you must follow the predominant e13 or e14 BCR/ABL type of transcript.
Last edit: 1 week 2 days ago by arlene.
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  • Delphine Rea
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3 days 3 hours ago #2098 by Delphine Rea
Replied by Delphine Rea on topic Molecular monitoring
Usually e19a2 constitute a minority and most CML MRD is made of Major transcripts.
Monitoring should thus be done using major transcript tools.
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  • Jeff Lipton
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2 days 7 hours ago #2100 by Jeff Lipton
Replied by Jeff Lipton on topic Molecular monitoring
I agree with Delphine and I think it is important to put this into perspective. A large part if not majority of the world does not have access to accurate and timely pcr monitoring. Those of us with a lot of resources at our fingertips often forget this. Monitor what can be done readily and that should support the patients. Perhaps in the future, all of us will have access to all drugs and all technology.
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