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