The problem of treatment failure of tyrosine kinase inhibitors and interferon alfa in chronic myelogenous leukemia without mutations in the BCR-ABL1 gene — a 27-year-old woman case

Abstract

Despite the breakthrough achieved by introducing tyrosine kinase inhibitors (TKI) for clini­cally treating patients with chronic myelogenous leukemia (CML), some nevertheless, do not exhibit any cytogenetic response. Such outcomes arise from mutations in the ABL1 domain of the BCR-ABL1 gene and also through non-optimal dosing of TKI, that result from their treatment intolerance leading to a temporary suspension, dose reduction or discontinuation in their use. Another significant factor contributing to the lack of cytogenetic response can be patient non-compliance with the clinician’s instructions. A case study is described of a 27-year-old female patient suffering from CML when imatinib, dasatinib, nilotinib and interferon alpha treatment had proved unsuc­cessful. Treatment intolerance during their successive use was manifested by cytopenia, liver damage features and skin lesions. It was thus necessary to reduce the treatment intensity, however as a consequence, there was no cytogenetic response. No mutation in the BCR-ABL1 was found. Regardless of the applied treatment, the patient only managed to achieve a full hematologic remission.