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CML and MDS 7q-

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8 years 7 months ago #1051 by aliciama@mednet.org.uy
CML and MDS 7q- was created by aliciama@mednet.org.uy
Dear Collegues I will very much appreciate your opinion about this case : Male 41 yo, two half brothers, good perfomance status. CML diagnosed in november 2013 and treated with Imatinib 400 mg(in our country we must begin CML treatmente with Imatinib) . Bad hematological tolerance with leucopenia which requiried GF and plaquetopenia. Imatinib dose reduction 300 mg.A minor molecuar response was obteined. Change to Dasatinib with worsening the hematological tolerance.

A bone marrow biopsy test showed myielodisplasic cytological changes.and a cytogenetic with 30% Phi Chromosome and in the cells Phi negative appear 7q- monosomy.

At that time is without TKI. The blood counts 2.400 white cells Hb12.6 Plt 111.000.

What do you recommend to do? Is the allo transplant indicated? As he has just two half brothers the unrelated bone marrow transplant should be search. If not UBMT is obtained the haploidentical transplant?
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  • Michele Baccarani
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8 years 7 months ago #1056 by Michele Baccarani
Replied by Michele Baccarani on topic CML and MDS 7q-
From the data, I recommend stem cell transplantation. The choice of the donor depends on local experience and facilities.

However, the level of this recommendation is low. More data are necessary. Where Ph neg 7q- cells detected also at diagnosis? How many Ph neg 7q- metaphases? One or more than one? Other chromosomal abnormalities in Ph+ cells? Which risk (Sokal or EURO or EUTOS) baseline?

Best regards, Michele Baccarani
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  • Jeff Lipton
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8 years 7 months ago #1057 by Jeff Lipton
Replied by Jeff Lipton on topic CML and MDS 7q-
this is a serious case
generally new chromosome abnormalities in Ph-neg cells can be "benign" if they include things like trisomy 8 which is probably the most common. These patients should be monitored.
7q- or monosomy 7 however is bad news. I agree with Michele that you should confirm if this is clonal, ie more than one metaphase with this abnormality
We actually reported in detail the natural history of such a case a few years ago.
Ostro D, Chun K, Kamel-Reid S, Lipton JH (2007) Chromosomal Abnormalities in Chronic Myeloid Leukemia: Evidence of a Hierarchy in Imatinib Treated Cells. Leuk Lymph 48: 195-6
This patient will very likely go on to develop AML, not CML blast crisis, but 7q- AML which will be hard to treat.
You may find that stopping the TKI may allow the CML to re-emerge and this MDS clone transiently disappear, but in the long run, I expect your patient is in for problems.
I agree completely that you should aggressively pursue the unrelated donor search and if no MUD, then consider a cord if possible. Given the need for GVH/GVL with CML, I would be concerned that a haplo might be too immunosuppressive and relapse would be higher than the usual approx 40%.
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