The Therapeutic Approach for Relapsed CML
The Therapeutic Approach for Relapsed CML
A Patient With Relapsed CML and Comorbidities
December 2015
- A 64-year-old male presented to his PCP with symptoms of fever, LUQ pain, and severe fatigue.
- PMHx:
- 2012: fainting associated with Long QT syndrome managed on propranolol.
- 2014: stage 3 kidney disease (GFR; 45 mL/min)
- 2014: NSCLC, stage IIA squamous histology treated with resection and chemoradiotherapy, pleural effusion managed with thoracentesis
- PE: spleen palpable 1.5 inches below costal margin
- CBC:
- WBCs, 172,000/μL (metamyelocytes, 3%; myelocytes, 6%; basophils, 6%; blasts, 2%;
- HCT, 30%
- Platelets, 536,000/μL
- Hb, 9.9 g/dL
- Bone marrow biopsy: Ph+ in 20/20 metaphases
- Q-PCR; BCR-ABL1/ABL1 ratio, 90%
- The patient was started on therapy with imatinib 400 mg
- March 2015:BCR-ABL1, 10% Q-PCR
- June 2015:BCR-ABL1, 6% Q-PCR
- September 2015:BCR-ABL1, 9% Q-PCR
December 2016:
- BCR-ABL1, 15% Q-PCR
- Bone marrow biopsy: Ph+ in 10/20 metaphases
- Genetic testing was negative for known TKI resistance mutations
- CBC normal count
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