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CML IN BLAST PHASE

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1 month 2 weeks ago #1870 by cguidali
CML IN BLAST PHASE was created by cguidali
We have a patient of 43 years old, diagnosed of accelerated phase cml in november 2021. Constitutional symptoms and GIV splenomegaly were the main symptoms. BM Immunophenotype: 16% myeloid blasts. BM CG: 100% Ph+. BCR-ABL + p210. He started treatment in another center outside Montevideo, with Imatinib 400mg day (most easily accessible in Uruguay). He had complete hematologic response. In April 2022 he discontinued tratment, evolving to a blastic phase in May.
BM Immunophenotype: 48% myelod blasts. CG/FISH: complex karyotype, t(9:22) in 67%. T315I negative. HLA study was perfomed. We started FLAG IDA protocol associated with Imatinib 800mg day. Nowadays he is at D17 postchemo. BM Immunophenotype: 60% myeloid blasts. We´re waiting for the authorization of Dasatinb by our government comitee.
We would appreciate your opinion about how to continue the treatment in this case, wich is the best chimio option.

Best regards, Camila Guidali MD, from Montevideo Uruguay
  • Kendra Sweet
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1 week 4 days ago - 1 week 4 days ago #1878 by Kendra Sweet
Replied by Kendra Sweet on topic CML IN BLAST PHASE
I always go straight to ponatinib in a blast phase CML patient, so if there is a possibility of getting ponatinib approval I would try ponatinib 45mg daily. Given that FLAG-Ida didn’t have any impact on the blast percentage, I would honestly try single agent ponatinib 45mg for 1-2 months to see how he responds to that. If he doesn’t get back into chronic phase, then perhaps add decitabine or azacitidine to the ponatinib. Obviously, this patient requires an allogeneic stem cell transplant as soon as he is back in chronic phase, so hopefully that is an option for him. I would recommend continuing the TKI as maintenance after transplant as well.

I don’t think I would give additional cytotoxic chemotherapy to this patient considering he received FLAG-Ida and didn’t derive any benefit what-so-ever.
Last edit: 1 week 4 days ago by arlene.
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