Dear Colleagues,
I would greatly value your thoughts a female patient.
Presented in summer 2012, age early 60s, with weight loss and progressive fatigue. Spleen enlarged 18cm bcm Hb 78, WBC 346 (24 basophils, absolute count), platelets 733. Bone marrow showed CML in chronic phase, cytogenetics showed Ph only, QPCR was 432%. She had a couple of weeks of Hydroxyurea while the diagnosis was being established, then had imatinib 400 for 10 weeks, getting eventually very unpleasant cutaneous problems. At that point she had a spleen still just palpable, and haemoglobin 113, total white count 6.5 and platelets 173. QPCR was 226%.
She switched to dasatinib 100 which has been well tolerated. After a further 8 weeks she has no palpable spleen, Hb 104, WBC 7.2, platelets 168. However QPCR is unchanged at 231%. We have screened for mutations in the ABL kinase domain and found none.
So, high risk CML, 2 months of imatinib, not tolerated and although got haematological remission, no molecular response. 2 further months of treatment with Dasatinib, well tolerated, but no molecular response.
Would you think she should try Nilotinib, or compassionale access for Ponatinib, or start investigating transplant?
Many thanks for your thoughts.
Best wishes, Peter