Re: Clarification on 3-log reduction terminology

[Guest guest]

Here's another way to look at it-how it was explained to me by my

oncologist:

Say you started out with 1,000 000(million) cells. For every 1 log

reduction you take off 1 zero, so for a 3 log reduction you would go

from that 1 million cells down to 1000. I hope that makes a bit more

sense-sometimes the terminology just makes things more confusing,

than straight laymans terms. And yes everyone starts out with a

different number unique to them.

>

> Hi --

> My husband, , goes in for his first PCR test this Friday, so we

are

> trying to get everything straight in our heads, in terms of

terminology,

> what to expect, etc! I think we pretty much understand it all

(thanks to you

> and many others on this forum!).....but when we read this part of

one of

> your recent emails, we had a question. You said:

>

> " The ultimate goal in CML is to achieve a " 3 log reduction " which

is a 1000

> fold decrease in cancer cells. "

>

> When you say a " 1000 fold decrease in cancer cells " , does that mean

it will

> be different for everyone? Meaning, his hope is to achieve a 1000-

fold

> decrease from he was first diagnosed at? For example, wont

have started

> his CML journey with a different " amount " of cancer cells than

others, so

> that his 3-log reduction will be specific and unique to him?

>

> I feel like I am not making sense! Sorry--worked an 12-hour day

today!!

> But--do you understand my question?

>

> Thanks as always!

>

> >From: " Tracey " <traceyincanada@...>

> >Reply-

> >

> >Subject: [ ] Re: CML Remission ?

> >Date: Fri, 09 Feb 2007 00:58:56 -0000

> >

> >Hi Efrem,

> >

> >There really isn't such a thing in CML as " remission " . The doctors

> >like to refer to it as a " response " .

> >

> >The first level of response is a " haematological response " . This

is

> >when your blood counts return to normal. Most people will achieve

> >this in a month but it's not unusual to see it take up to 3 months.

> >

> >The second level of response is a " cytogenetic response " . This is

> >when the number of Philadelphia chromosomes is reduced. If the

> >number of ph+ cells is above 35% but below 95% it is considered a

> >cytogenetic response. If the number of ph+ cells is between 5% and

> >35% then it is considered a major cytogenetic response (MCR). If

the

> >number of ph+ cells is 0% it is considered a complete cytogenetic

> >response (CCR). CCR usually happens within 6 months but some have

> >seen it as early as 3 months and others have taken a year or more.

> >

> >The ultimate goal in CML is to achieve a " 3 log reduction " which

is a

> >1000 fold decrease in cancer cells. This is measured using a PCR

> >test and can take a year or more to achieve. Some patients do even

> >better than this but with a 3 log reduction, the chances of relapse

> >are infinitesimal so this is the milestone you want to reach.

> >Anything more than this is just gravy.

> >

> >Current information indicates that we'll have to remain on Gleevec

> >for the rest of our lives. Those who have stopped taking it, have

> >almost all relapsed and some even became resistant when trying to

> >restart it.

> >

> >Take care,

> >Tracey

> >

> >

> >

> >--- In , " efrem_fischer " <efrem_fischer@>

> >wrote:

> > >

> > > Has anyone here, with CML, gone into remission?

> > > If so, how long did it take, from the time you started the

Gleevec?

> > >

> >

> >

>

> _________________________________________________________________

> Turn searches into helpful donations. Make your search count.

> http://click4thecause.live.com/search/charity/default.aspx?

source=hmemtagline_donation & FORM=WLMTAG

>

[Guest guest]

Hi ,

Technically speaking, yes, we all start out with different numbers

but since very few of us ever had PCR testing done on diagnosis and

since the labs need to have a specific target to aim for, they have

determined what a baseline number should be.

In determining this baseline, they used a number of newly diagnosed

patients and averaged out their counts to arrive to a specific value

that they consider a baseline reading. From that baseline value,

there is a very specific number given that would equate to a 3 log

reduction.

If someone starts out with a large leukemic load (larger than the

average), then technically when they reach the standard 3 log

reduction, it will actually be a bigger reduction for them and the

reverse would be true as well. If someone started out with a very

small leukemic load, then the 3 log reduction for them, is probably a

smaller decrease than for others but that doesn't mean that they

haven't reached the goal yet.

The 3 log values were determined for each lab, they weren't

determined using your particular baseline reading so if you reach the

3 log reduction, you have reached the level that the lab considers as

the level that will protect you the most from relapse.

If you were lucky enough to start off with a lower leukemic burden,

then the only significance that would have on the 3 log goal is that

you would probably reach it faster than someone who started out with

a larger load. So what you started with, isn't as important as where

you end up. I know it's confusing. I hope I haven't confused you

more.

Tracey

>

> Hi --

> My husband, , goes in for his first PCR test this Friday, so we

are

> trying to get everything straight in our heads, in terms of

terminology,

> what to expect, etc! I think we pretty much understand it all

(thanks to you

> and many others on this forum!).....but when we read this part of

one of

> your recent emails, we had a question. You said:

>

> " The ultimate goal in CML is to achieve a " 3 log reduction " which

is a 1000

> fold decrease in cancer cells. "

>

> When you say a " 1000 fold decrease in cancer cells " , does that mean

it will

> be different for everyone? Meaning, his hope is to achieve a 1000-

fold

> decrease from he was first diagnosed at? For example, wont

have started

> his CML journey with a different " amount " of cancer cells than

others, so

> that his 3-log reduction will be specific and unique to him?

>

> I feel like I am not making sense! Sorry--worked an 12-hour day

today!!

> But--do you understand my question?

>

> Thanks as always!

>

> >From: " Tracey " <traceyincanada@...>

> >Reply-

> >

> >Subject: [ ] Re: CML Remission ?

> >Date: Fri, 09 Feb 2007 00:58:56 -0000

> >

> >Hi Efrem,

> >

> >There really isn't such a thing in CML as " remission " . The doctors

> >like to refer to it as a " response " .

> >

> >The first level of response is a " haematological response " . This

is

> >when your blood counts return to normal. Most people will achieve

> >this in a month but it's not unusual to see it take up to 3 months.

> >

> >The second level of response is a " cytogenetic response " . This is

> >when the number of Philadelphia chromosomes is reduced. If the

> >number of ph+ cells is above 35% but below 95% it is considered a

> >cytogenetic response. If the number of ph+ cells is between 5% and

> >35% then it is considered a major cytogenetic response (MCR). If

the

> >number of ph+ cells is 0% it is considered a complete cytogenetic

> >response (CCR). CCR usually happens within 6 months but some have

> >seen it as early as 3 months and others have taken a year or more.

> >

> >The ultimate goal in CML is to achieve a " 3 log reduction " which

is a

> >1000 fold decrease in cancer cells. This is measured using a PCR

> >test and can take a year or more to achieve. Some patients do even

> >better than this but with a 3 log reduction, the chances of relapse

> >are infinitesimal so this is the milestone you want to reach.

> >Anything more than this is just gravy.

> >

> >Current information indicates that we'll have to remain on Gleevec

> >for the rest of our lives. Those who have stopped taking it, have

> >almost all relapsed and some even became resistant when trying to

> >restart it.

> >

> >Take care,

> >Tracey

> >

> >

> >

> >--- In , " efrem_fischer " <efrem_fischer@>

> >wrote:

> > >

> > > Has anyone here, with CML, gone into remission?

> > > If so, how long did it take, from the time you started the

Gleevec?

> > >

> >

> >

>

> _________________________________________________________________

> Turn searches into helpful donations. Make your search count.

> http://click4thecause.live.com/search/charity/default.aspx?

source=hmemtagline_donation & FORM=WLMTAG

>

[Guest guest]

This is a good way of looking at--thanks!

>From: sassysus06 <no_reply >

>Reply-

>

>Subject: [ ] Re: Clarification on 3-log reduction terminology

>Date: Thu, 15 Feb 2007 17:20:39 -0000

>

>Here's another way to look at it-how it was explained to me by my

>oncologist:

>

>Say you started out with 1,000 000(million) cells. For every 1 log

>reduction you take off 1 zero, so for a 3 log reduction you would go

>from that 1 million cells down to 1000. I hope that makes a bit more

>sense-sometimes the terminology just makes things more confusing,

>than straight laymans terms. And yes everyone starts out with a

>different number unique to them.

>

>

>

> >

> > Hi --

> > My husband, , goes in for his first PCR test this Friday, so we

>are

> > trying to get everything straight in our heads, in terms of

>terminology,

> > what to expect, etc! I think we pretty much understand it all

>(thanks to you

> > and many others on this forum!).....but when we read this part of

>one of

> > your recent emails, we had a question. You said:

> >

> > " The ultimate goal in CML is to achieve a " 3 log reduction " which

>is a 1000

> > fold decrease in cancer cells. "

> >

> > When you say a " 1000 fold decrease in cancer cells " , does that mean

>it will

> > be different for everyone? Meaning, his hope is to achieve a 1000-

>fold

> > decrease from he was first diagnosed at? For example, wont

>have started

> > his CML journey with a different " amount " of cancer cells than

>others, so

> > that his 3-log reduction will be specific and unique to him?

> >

> > I feel like I am not making sense! Sorry--worked an 12-hour day

>today!!

> > But--do you understand my question?

> >

> > Thanks as always!

> >

> > >From: " Tracey " <traceyincanada@...>

> > >Reply-

> > >

> > >Subject: [ ] Re: CML Remission ?

> > >Date: Fri, 09 Feb 2007 00:58:56 -0000

> > >

> > >Hi Efrem,

> > >

> > >There really isn't such a thing in CML as " remission " . The doctors

> > >like to refer to it as a " response " .

> > >

> > >The first level of response is a " haematological response " . This

>is

> > >when your blood counts return to normal. Most people will achieve

> > >this in a month but it's not unusual to see it take up to 3 months.

> > >

> > >The second level of response is a " cytogenetic response " . This is

> > >when the number of Philadelphia chromosomes is reduced. If the

> > >number of ph+ cells is above 35% but below 95% it is considered a

> > >cytogenetic response. If the number of ph+ cells is between 5% and

> > >35% then it is considered a major cytogenetic response (MCR). If

>the

> > >number of ph+ cells is 0% it is considered a complete cytogenetic

> > >response (CCR). CCR usually happens within 6 months but some have

> > >seen it as early as 3 months and others have taken a year or more.

> > >

> > >The ultimate goal in CML is to achieve a " 3 log reduction " which

>is a

> > >1000 fold decrease in cancer cells. This is measured using a PCR

> > >test and can take a year or more to achieve. Some patients do even

> > >better than this but with a 3 log reduction, the chances of relapse

> > >are infinitesimal so this is the milestone you want to reach.

> > >Anything more than this is just gravy.

> > >

> > >Current information indicates that we'll have to remain on Gleevec

> > >for the rest of our lives. Those who have stopped taking it, have

> > >almost all relapsed and some even became resistant when trying to

> > >restart it.

> > >

> > >Take care,

> > >Tracey

> > >

> > >

> > >

> > >--- In , " efrem_fischer " <efrem_fischer@>

> > >wrote:

> > > >

> > > > Has anyone here, with CML, gone into remission?

> > > > If so, how long did it take, from the time you started the

>Gleevec?

> > > >

> > >

> > >

> >

> > _________________________________________________________________

> > Turn searches into helpful donations. Make your search count.

> > http://click4thecause.live.com/search/charity/default.aspx?

>source=hmemtagline_donation & FORM=WLMTAG

> >

>

>

_________________________________________________________________

Check out all that glitters with the MSN Entertainment Guide to the Academy

Awards® http://movies.msn.com/movies/oscars2007/?icid=ncoscartagline2

[Guest guest]

Hi all,

I am going to provide my way of looking at a 3 log

reduction. I heard this from Dr. Drucker - but my

bet is I did not fully absorb it completely. Also I

don't this he gave me a starting baseline reading. I

think I heard a starting baseline of 09.0000 from

another source.

So if you start with a 09.000 reading then a 1 log

reduction would be 00.900. A 2 log reduction would

be 00.090 and a 3 log reduction would equate to

00.009.

Now, I have my own issues. As I may have mentioned in

the past, I have had at least 3 different labs used

by the different Drs and hospitals I have visited.

Good news is that the last 2 years at OHSU I was

00.000!

Bad news (or less than great news) is that LabCorp

reported numbers in this range. 00.038 and 00.050.

I have had two different break point unidentified at

Labcorp and by Dana Farber. I was told that 2

different break points is not a big issue and somewhat

common. But if you add the the 2 #s together - which

Dr Denninger said he thought was appropriate I get a

number like 00.088. That's a low number and I am

happy but not a 3 log reduction.

I don't worry too much about the different readings -

but I do press hard for my local oncologist to stick

with one lab.

Once again, I am a part time member here and I defer

to many others who have studied this and are kind

enough to share their expertise.

Thanks,

Chris

--- Cervera <weez_555@...> wrote:

> This is a good way of looking at--thanks!

>

>

>

> >From: sassysus06 <no_reply >

> >Reply-

> >

> >Subject: [ ] Re: Clarification on 3-log

> reduction terminology

> >Date: Thu, 15 Feb 2007 17:20:39 -0000

> >

> >Here's another way to look at it-how it was

> explained to me by my

> >oncologist:

> >

> >Say you started out with 1,000 000(million) cells.

> For every 1 log

> >reduction you take off 1 zero, so for a 3 log

> reduction you would go

> >from that 1 million cells down to 1000. I hope that

> makes a bit more

> >sense-sometimes the terminology just makes things

> more confusing,

> >than straight laymans terms. And yes everyone

> starts out with a

> >different number unique to them.

> >

> >

> >

> > >

> > > Hi --

> > > My husband, , goes in for his first PCR test

> this Friday, so we

> >are

> > > trying to get everything straight in our heads,

> in terms of

> >terminology,

> > > what to expect, etc! I think we pretty much

> understand it all

> >(thanks to you

> > > and many others on this forum!).....but when we

> read this part of

> >one of

> > > your recent emails, we had a question. You said:

> > >

> > > " The ultimate goal in CML is to achieve a " 3 log

> reduction " which

> >is a 1000

> > > fold decrease in cancer cells. "

> > >

> > > When you say a " 1000 fold decrease in cancer

> cells " , does that mean

> >it will

> > > be different for everyone? Meaning, his hope is

> to achieve a 1000-

> >fold

> > > decrease from he was first diagnosed at? For

> example, wont

> >have started

> > > his CML journey with a different " amount " of

> cancer cells than

> >others, so

> > > that his 3-log reduction will be specific and

> unique to him?

> > >

> > > I feel like I am not making sense! Sorry--worked

> an 12-hour day

> >today!!

> > > But--do you understand my question?

> > >

> > > Thanks as always!

> > >

> > > >From: " Tracey " <traceyincanada@...>

> > > >Reply-

> > > >

> > > >Subject: [ ] Re: CML Remission ?

> > > >Date: Fri, 09 Feb 2007 00:58:56 -0000

> > > >

> > > >Hi Efrem,

> > > >

> > > >There really isn't such a thing in CML as

> " remission " . The doctors

> > > >like to refer to it as a " response " .

> > > >

> > > >The first level of response is a

> " haematological response " . This

> >is

> > > >when your blood counts return to normal. Most

> people will achieve

> > > >this in a month but it's not unusual to see it

> take up to 3 months.

> > > >

> > > >The second level of response is a " cytogenetic

> response " . This is

> > > >when the number of Philadelphia chromosomes is

> reduced. If the

> > > >number of ph+ cells is above 35% but below 95%

> it is considered a

> > > >cytogenetic response. If the number of ph+

> cells is between 5% and

> > > >35% then it is considered a major cytogenetic

> response (MCR). If

> >the

> > > >number of ph+ cells is 0% it is considered a

> complete cytogenetic

> > > >response (CCR). CCR usually happens within 6

> months but some have

> > > >seen it as early as 3 months and others have

> taken a year or more.

> > > >

> > > >The ultimate goal in CML is to achieve a " 3 log

> reduction " which

> >is a

> > > >1000 fold decrease in cancer cells. This is

> measured using a PCR

> > > >test and can take a year or more to achieve.

> Some patients do even

> > > >better than this but with a 3 log reduction,

> the chances of relapse

> > > >are infinitesimal so this is the milestone you

> want to reach.

> > > >Anything more than this is just gravy.

> > > >

> > > >Current information indicates that we'll have

> to remain on Gleevec

> > > >for the rest of our lives. Those who have

> stopped taking it, have

> > > >almost all relapsed and some even became

> resistant when trying to

> > > >restart it.

> > > >

> > > >Take care,

> > > >Tracey

> > > >

> > > >

> > > >

> > > >--- In , " efrem_fischer "

> <efrem_fischer@>

> > > >wrote:

> > > > >

> > > > > Has anyone here, with CML, gone into

> remission?

> > > > > If so, how long did it take, from the time

> you started the

> >Gleevec?

> > > > >

> > > >

> > > >

> > >

> > >

>

_________________________________________________________________

> > > Turn searches into helpful donations. Make your

> search count.

> > >

>

http://click4thecause.live.com/search/charity/default.aspx?

> >source=hmemtagline_donation & FORM=WLMTAG

> > >

> >

> >

>

>

_________________________________________________________________

> Check out all that glitters with the MSN

> Entertainment Guide to the Academy

> Awards®

>

http://movies.msn.com/movies/oscars2007/?icid=ncoscartagline2

>

>

>

>

>

[Guest guest]

Hi

You're absolutely right. For every log, you move the decimal over by

one. Furthermore, you raise an important point about sticking to one

lab.

Each lab has their own baseline values and their own values that

equate to the 3 log reduction. For example, I've heard that the 3

log reduction mark at MDACC is 0.05 but at many other labs, this

would only be a 2 log reduction. That's why it's important not only

to know what values your lab is using but it's also good to stick

with the same lab for the sake of consistency.

Tracey

>

> Hi all,

>

> I am going to provide my way of looking at a 3 log

> reduction. I heard this from Dr. Drucker - but my

> bet is I did not fully absorb it completely. Also I

> don't this he gave me a starting baseline reading. I

> think I heard a starting baseline of 09.0000 from

> another source.

>

> So if you start with a 09.000 reading then a 1 log

> reduction would be 00.900. A 2 log reduction would

> be 00.090 and a 3 log reduction would equate to

> 00.009.

>

> Now, I have my own issues. As I may have mentioned in

> the past, I have had at least 3 different labs used

> by the different Drs and hospitals I have visited.

>

> Good news is that the last 2 years at OHSU I was

> 00.000!

>

> Bad news (or less than great news) is that LabCorp

> reported numbers in this range. 00.038 and 00.050.

> I have had two different break point unidentified at

> Labcorp and by Dana Farber. I was told that 2

> different break points is not a big issue and somewhat

> common. But if you add the the 2 #s together - which

> Dr Denninger said he thought was appropriate I get a

> number like 00.088. That's a low number and I am

> happy but not a 3 log reduction.

>

> I don't worry too much about the different readings -

> but I do press hard for my local oncologist to stick

> with one lab.

>

> Once again, I am a part time member here and I defer

> to many others who have studied this and are kind

> enough to share their expertise.

>

>

> Thanks,

>

>

> Chris

>