I would be grateful for your advice in the management of a patient, aged 47, who’s variant t(9;11) by FISH in her BMA is 36.5% (73/200 cells) and her BCR/ABL in her BMA is 37.600 three months post Dasatinib 100mg daily, but six months from diagnosis (three months on Imatinib 600mg).
Patient history
Chronic myeloid leukaemia, chronic phase (CML-CP) – August 2012
Sokal score 2.82 (High),
Hasford 1564.28 (High),
EUTOS score 113 or high risk group, EUTOS probability for no CCgr 0.27
Aug 12 - PB% =321.000, BM karyotype 46,XX,t(9;11)(q34;q13)[20]*
Imatinib 600mg
Oct 12 - PB% = 37.300
Nov 12 - BMA % = 69.500, BM karyotype 46,XX,t(9;22;11)q34;q11.2;q13)[20].
Imatinib 600mg ceased 6th Nov, Dasatinib 8th Nov, Dasatinib 100mg daily Nov 2012
Feb 13 - BMA % 37.600 BM FISH 73/200 36.5%
Medications: Dasatinib 100mg daily
Blood results: Hb 118, WBC 9.3, Plts 244, N 2.5, Lymph 6.,creat 101, ALP 16, GGT 9, calcium 2.4, magnesium 0.8. PBF reactive lymphocytes (viral illness in Dec)
She has achieved almost normal haematological values, her splenomegaly is not longer palpable, has no side effects on Dasatinib and compliance to her medication is excellent.
Her TK mutation studies did not detected a mutation.
The questions I have are:
Do we continue Dasatinib in the meantime with monthly BCR/ABL’s?
If so, what parameters of response should I follow and what alternatives of treatment are advisable?
Do you think HLA typing from her siblings would be advisable at this stage?
Dr Hilda Mangos
Southland Hospital
New Zealand