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To share and enhance best practice management of CML, experts and interested clinicians can discuss difficult or interesting CML patient cases here. Clinicians submit a brief history of the patient and the case for discussion (no more than 200 words) by posting it in this forum ("+ NEW TOPIC" button below).

Each clinical case will be forwarded to the iCMLf expert clinical panel for a brief independent response. Consideration should be given to patient confidentiality. Details that are not critical to the case can be changed to preserve anonymity.

As a full clinical history is necessary for accurate comment, cases and comments on the Forum are only accepted from clinicians. If individual patients have a specific question we encourage them to contact their healthcare provider.

DISCLAIMER: The iCMLf does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this Forum is solely at your own risk.

TOPIC: Frontline investigations and choice of TKI

Frontline investigations and choice of TKI 5 months 2 weeks ago #1601

  • Saurabh Bhave
  • Saurabh Bhave's Avatar
We have a 74 year diabetic lady
Newly diagnosed CML
Sokal score high

Questions

1. Are you doing Bone marrow at diagnosis in 74 year old lady ?
2. Your choice of TKI in this patient will be imatinib or dasatinib ?

Frontline investigations and choice of TKI 5 months 2 weeks ago #1602

  • Tim Hughes
  • Tim Hughes's Avatar
We still do a bone marrow at diagnosis to exclude advanced phase disease and to look at cytogenetics. I agree the value is limited in patients where an allograft would never be a consideration and I wouldn’t push too hard in these patients if they were not keen to have it done.

I would generally prefer a second gen TKI in patients with high Sokal score and dasatinib would be a good choice in this lady. I might not use 100 mg/day though – given her age-related high risk of pleural effusion. I would use 70 mg/day and only increase if her molecular response was not optimal.

Frontline investigations and choice of TKI 5 months 2 weeks ago #1603

  • JEFF LIPTON
  • JEFF LIPTON's Avatar
Definitely agree with Tim with one minor exception. Given her age and co-morbidities, I would go with 50mg DAS. There are data from the OPTIM study, presented and soon to be published I hope, that suggests that 50mg is all that is needed. Increase dose if response is poor. Would not chase MR4.5 as an endpoint, but at least a stable CCyR or MMR. TFR should not be a major target on your radar. If she responds well and runs into toxicities, consider a switch to imatinib. Unless resistance and the appropriate mutation dictates, would avoid nilotinib because of the diabetes.
Moderators: Melissa Davis-Bishop
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