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Chronic Myeloid Leukemia Case Studies

Case Studies: The Therapeutic Approach for Relapsed CML

In this case-based interview, Javier A. Pinilla-Ibarz, MD, PhD, discusses an older patient with relapsed chronic myeloid leukemia and comorbidities, and the therapeutic management of this type of patient.

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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