Peripheral MDA

[Downriver555]

My Dr. doesnt think I really need a BMB to see if I am MRD negative. I finished my treatment of gazyva and veneteclax in May. What is the name of the test that is pheripheral to detect MRD status and how accurate is it.

Thanks

[LovecuresCLL]

I am exact same regimen and have one month of V pills left. They said I don’t need bone marrow biopsy either, I think they plan to do flow cytometry on my peripheral blood rather than on my bone marrow aspirate. I will let the group know more next week after my appointment .

-John

[Hidden]

it's a flow cytometry test geared toward finding MRD. thats most common. there are now far more expensive tests that look at more cells and are more accurate. NGS - next generation sequencing

[LovelyLilyGirl]

I’m 4 months into V+O. Only 2 infusions left in July. Yeah!!! My Dr. will be doing a flow cytometry test in August after I’ve finished my infusions. And then I will continue on my pills until March. At that point, he said he would do another flow cytometry test. He doesn’t do bone marrow biopsy‘s unless he feels like there’s residual cancer cells.

I hope you’ve done well on your treatment. My numbers were back within normal range so quickly it gave me great hope.

Sending best wishes.

-Sally

[Hidden]

Looks like progress.

good health,

Owen

[PlanetaryKim]

I'm same. My specialist is saying peripheral MRD test results correlate very closely to BMB test of same. So I think that is the plan when I finish venetoclax - peripheral only. I would feel more secure in the result with BMB though. It seems to me there has been more than one member here who has posted they were MRD negative on peripheral blood, but not quite there on BMB.

[AussieNeil Partner Administrator in reply to PlanetaryKim]

BMB is more accurate, given that's where the blood making action is, but the medical procedure is obviously a higher risk than a simple blood test, even before considering the big difference in cost. Generally BMB results don't show as great a degree of uMRD achievement as with peripheral blood. CLL cells are more vulnerable in the blood stream and lack their protective micro-environment that can help them survive treatment, so you are less likely to find surviving CLL cells in a blood test.

[PlanetaryKim in reply to AussieNeil]

That's what I thought. So I was surprised my specialist said peripheral MRD parallels marrow MRD quite closely and is sufficient. I think the reality is MRD testing not yet a funded practice here in BC. So when my time comes, I will be lucky to get even peripheral MRD test.

[AussieNeil Partner Administrator in reply to PlanetaryKim]

"Parallels" just means that the test results correlate, not that they are equivalent. Sufficient is what we have to accept when neither we nor our health systems can afford the testing. My doctor (surprisingly to me) agreed to me having an immunophenotype test (i.e. the flow cytometry test used to diagnose CLL over a month ago. According to that test result, I no longer have CLL, as no clonal B-lymphocytes were detected - well no B cells for that matter! It's not an MRD test, but it's encouraging non the less.

[PlanetaryKim in reply to AussieNeil]

Congratulations on that!

[Sushibruno in reply to AussieNeil]

That's great news! I hope in a few years this proofs to be the case for everyone. I would love to say "so long cll have a nice trip".

[studebaker in reply to AussieNeil]

That is excellent progress Neil.

[DisneyMom in reply to PlanetaryKim]

I know that here in Ontario, my oncologist said that we don't have the capability to test MRD, which is why he wants me to go through all 6 rounds of FCR.

[PlanetaryKim in reply to DisneyMom]

Here too in BC my specialist said same... but he also said that by time I am finished with venetoclax (Feb 2022), they hope to have MRD testing funding and on the books. So they are working on it.

[johnl in reply to PlanetaryKim]

in the trial i'm in I often have both at once. they only differ by 0.01.

john

[PlanetaryKim in reply to johnl]

interesting! Good to know. Still... that 0.01 could be the difference between being declared u-MRD and not.

[johnl in reply to PlanetaryKim]

But UMRD like age is just a number.

john

[PlanetaryKim in reply to johnl]

so true!

[bkoffman CLL CURE Hero]

Great news. Flow cytometry measures goes to 1/10,000 CLL cells and is the standard way to check for MRD status. ClonoSeq using NGS and may be accurate down to 1 in a million and is approved now in the USA. There is a good correlation between MRD in the blood and marrow with VenG that you had, but clearly there is less uMRD found in the marrow than in the blood in most trials. uMRD status in blood and marrow are more tightly linked with the combination of V+I. Stay strong. we are all in this together. Brian CLLSociety.org

[ttomo in reply to bkoffman]

Thanks for this explanation, Brian. I’m in a trial which ends in three weeks at which time I will have a bone marrow biopsy. Is there a reason, other than cost, why they never checked MRD in the blood perhaps every quarter during the course of the trial? It would seem that that would be helpful and definitely encouraging for the patient (assuming successful trends). Be well!

[bkoffman CLL CURE Hero in reply to ttomo]

No need to do MRD testing until CBC is normal. Every 3 months seems too often.

[ttomo in reply to bkoffman]

Thanks. My CBC was normal after three months of treatment. Are you saying that at least one MRD test would have been appropriate then?

[bigunwill2 in reply to bkoffman]

Thanks for explanation. I tested MRD positive on BMB using the more sensitive test, but the report said I had .02% CLL cells. I took this as good news.

[bkoffman CLL CURE Hero in reply to bigunwill2]

So would I. But I might continue treatment to see if you could driver it lower.

[bigunwill2 in reply to bkoffman]

I started on acalabrutinib on Friday.

[Awksom]

I just had a peripheral blood MRD flow and was negative. But my BMB showed 0.4%. Apparently about 15% of patients show this discordance. So I keep going a few more cycles.

[bkoffman CLL CURE Hero in reply to Awksom]

I would agree.

[Smakwater]

Downriver555,

The cut hay should be in the stack. Next years seed should still be in a sack.

Some measure the next crop by what they have put up in the past, and others look at what happens where the seed in in the ground.

BNB is more like checking for seeds in the soil, rather than looking at the top of the ground after spraying roundup.

JM