I look after an extremely youthful 80yo man with CML in sustained CMR who is keen to come off his (well tolerated, asymptomatic) dasatinib. The large sticking point for me is that he was in AP at diagnosis.
Early 2016, evolving CBC abnormalities (anaemia, marked basophilia, some dysplasia); BMBx showed CML, karyotype ISCN Karyotype (2013): 46,XY,t(9;22)(q34;q11.2),i(17)(q10)[4]/47,sl,+8[11] , therefore AP by WHO classification
PB basophils 5.2 (29%)
BMBx – blasts 5%, basophils 16%
Sokal 0.99 / Hasford 1137, both intermediate
Started dasatinib 100mg OD in June 2016; rapid CHR (PB basophils 5 to N in 2 weeks), Q-PCR 0.002% @ 3 months and has been negative (GeneXpert platform) from 6/12 (so now over 3 years)
Remains on dasatinib 70mg OD (reduced early on for cytopenias) with persistently normal CBC / negative Q-PCR
This is not a situation where I can find evidence for or against stopping. There are obvious pointers to success (extremely good response) and failure (poor disease at baseline). I’m interested in your view.