Complete molecular response achieved on the third-line nilotinib therapy in a patient with chronic myelogenous leukemia in chronic phase intolerant to imatinib and dasatinib

Abstract

Non-hematological toxicity of imatinib (IM) and dasatinib could result from more potent inhibition of other than bcr/abl1 tyrosine kinases and inhibition of additional pathways related to SRC kinase family. The case of a patient with chronic myelogenous leukemia in chronic phase who permanently discontinued IM due to extensive skin leasions, and dasatinib administered as a second-line treatment due to recurrent pericardiac effusions is described. Under IM as well as under dasatinib therapy an optimal response according to European LeukemiaNet criteria was achieved. After introduction of nilotinib neither signs of IM cross-intolerance nor reoccurrence of pericardiac effusion were noted. After 9 months of therapy with nilotinib the number of bcr/abl1 transcripts was reduced by 1 logarithm and reached the level recognized previously as a complete molecular response which is durable (follow-up 21 months).