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Blast crisis with immature double population

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4 weeks 1 day ago - 3 weeks 7 hours ago #1832 by marianna.lima
Male patient, 42 years old, diagnosed with CML (positive BCR / ABL), in the diagnosis presented in bone marrow immunophenotyping two populations of blasts: t lymphoid populations (0.45%) + myeloblasts (1.34%) totaling 1.78 immature cells). Description of grade 3 fibrosis. Treatment initiated with imatinib.

It evolved with the appearance of multiple tumors and showed granulocytic sarcoma.

Questions :

In treatment, ITK Dasatinib should be associated with which systemic chemotherapy. Should I opt for chemotherapy directed at the myeloid component (7 + 3) or T lymphoid (HyperCVAD) or both (FLAG-IDA?

When choosing therapy, should we consider grade 3 bone marrow fibrosis?

There's a new bone marrow evaluation schedule with immunophenotyping that we still don't have the result for. In evaluating possible donors for ongoing transplants.
Last edit: 3 weeks 7 hours ago by arlene.
  • Andreas Hochhaus
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3 weeks 6 hours ago - 3 weeks 6 hours ago #1833 by Andreas Hochhaus
Replied by Andreas Hochhaus on topic Blast crisis with immature double population
I would resist to apply a full dose combination chemotherapy. Recovery of normal hematopoiesis is impossible in CML and the whole treatment aims to prepare for transplant.

Therefore, Dasatinib 100 mg/d should be the start, combined with an individually dosed chemotherapy with Ara-C and a intermediate dose of an anthracyclin.

A full dosed 7+3 or similar will result in long lasting cytopenias and may be disadvantageous.

With some more information about timing (diagnosis until myeloid sarcoma, histology of the lesions (% blasts), BCR-ABL mutations, cytogenetics) I would be happy to provide more detailed advice if you would like me to.
Last edit: 3 weeks 6 hours ago by arlene.
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