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CP-CML with LN involvement

  • Ehab Atallah
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2 months 3 weeks ago - 2 months 2 weeks ago #2030 by Ehab Atallah
CP-CML with LN involvement was created by Ehab Atallah
Dear all, 

I am seeing a 52 year old, CP-CML. NGS normal. At time of presentation had a mammogram which demonstrated an enlarged LN. Biopsy from LN showed mature neutrophils and involvement by CML. No blasts. Started asciminib. Would you do anything different?

Thanks, 
Ehab
Last edit: 2 months 2 weeks ago by arlene.
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  • Elisabetta Abruzzese
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2 months 2 weeks ago - 3 weeks 1 day ago #2031 by Elisabetta Abruzzese
Replied by Elisabetta Abruzzese on topic CP-CML with LN involvement
Was the lymph node surgically excised, or was the diagnosis made via needle biopsy?

Was a PET scan performed to assess for hypermetabolic activity both at the site and elsewhere?

I would have considered consulting with radiation oncology to evaluate the potential role of local radiotherapy to the involved node or field.

Other than that, to my knowledge, there is limited data regarding the efficacy of asciminib in extramedullary disease. However, I agree that in a relatively young patient with an unusual site of extramedullary involvement, using a potent and novel agent like asciminib is a reasonable approach.

An alternative consideration could have been dasatinib, given its known activity in extramedullary sites and in blast phase CML. If this lymph node involvement is interpreted as a myeloid sarcoma, would that reclassify the disease as being in blast phase? This point might warrant further discussion.
Last edit: 3 weeks 1 day ago by arlene.
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  • Massimo Breccia
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3 weeks 1 day ago #2033 by Massimo Breccia
Replied by Massimo Breccia on topic CP-CML with LN involvement
I believe that the choice of the drug is correct if the patient is in CP. I suggest only a close follow-up of all the superficial LN during the treatment.
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  • Žáčková Daniela
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3 weeks 1 day ago #2034 by Žáčková Daniela
Replied by Žáčková Daniela on topic CP-CML with LN involvement
Interesting case, pretty uncommon. I’d do the same. Let us know how it turns out!
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  • Nicholas Anthony Othieno-Abinya
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2 weeks 5 days ago #2036 by Nicholas Anthony Othieno-Abinya
Replied by Nicholas Anthony Othieno-Abinya on topic CP-CML with LN involvement
In our manuscript awaiting publication we have described lymphadenopathy in CPCML. These cases tend to be associated with lower peripheral blood wbc counts and lower absolute neutrophil counts than the average. We start them all on imatinib, but have not profiled their outcome in relation to the rest.
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  • Shoaib Akhter
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2 weeks 2 days ago #2038 by Shoaib Akhter
Replied by Shoaib Akhter on topic CP-CML with LN involvement
I discussed it with my colleagues from clinical hematology. First of all is it's is FNAC of excision of lymph node. As in FNAC blast may be missed. And also to look for history of infection for lymph nodes. And regard to treatment it is right option.
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