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Chronic Myeloid Leukemia Case Studies

Case Studies: Managing Relapsed Chronic Myeloid Leukemia

In this case-based interview, Michael J. Mauro, MD, provides an overview on the therapeutic management of a younger patient with relapsed chronic myeloid leukemia.

Managing Relapsed Chronic Myeloid Leukemia

Case: A Younger Patient With Relapsed CML

May 2013

  • A 48-year-old female was diagnosed with CP-CML with a splenomegaly, 3.2 cm below the costal margin
  • Laboratory values:
    • WBCs, 157,000/μL
    • HCT, 30% hematocrit
    • Platelets, 359,000/μL
    • Myeloblasts, 6%
  • Bone marrow biopsy: Ph+ in 20/20 metaphases
  • Q-PCR, showed a BCR-ABL1/ABL1 ratio of 176%
  • The patient was started on dasatinib 100 mg; she achieved MMR after 6 months, and a deeper molecular remission (>MR4) after 12 months on therapy and remained in remission for 3 years

December 2016

  • The patient complained of increasing fatigue and weight loss.
  • Q-PCR showed a significant increase in BCR-ABL1 transcript ratio (to 50% IS)
  • Bone marrow biopsy; 80% cellularity, 18/20 Ph+ metaphases
  • Mutation testing showed the presence of T315I
  • The patient was started on ponatinib 45 mg daily
  • She developed grade 3 thrombocytopenia; the ponatinib dose was reduced to 30 mg daily

March 2017

  • Cytogenetics, 3/20 Ph+ metaphases
  • BCR-ABL1 transcript ratio, 5%

June 2017

  • BCR-ABL1 transcript ratio, 0.75%.

October 2017

  • BCR-ABL1 transcript ratio, 0.01% and no T315I mutation was detected
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