Nilotinib treatment of a patient with chronic myelogenous leukemia after previous failure to imatinib and dasatinib

Abstract

Introduction of tyrosine kinase inhibitors (TKI) in chronic myelogenous leukemia (CML) has
significantly improved prognosis. Unfortunately, upon the introduction of TKI treatment, cases of
treatment failure and numerous side effects have been raported. In this paper we present a case
of a patient diagnosed with CML whose treatment was initiated prior to introduction of TKI.
Initially, the patient received hydroxyurea and interferon. First-line TKI treatment — imatinib
— proved to be ineffective. After 6 months of treatment a minimal cytogenetic response (75% of
Philadelphia+ [Ph+] cells) was achieved. After 12 months of treatment, no cytogenetic response to imatinib (100% Ph+ cells) was observed. 2nd-line treatment with dasatinib was included.
Despite the efficacy of the treatment (the desired levels of cytogenetic and molecular remission were
achieved), the treatment was discontinued due to complications. After 6 days of treatment pleural
effusion has been reported. Which after discontinuation of therapy and conservative treatment.
Relapse of effusion was observed after 6 years of therapy. The presence of fluid in the pleural
cavity was accompanied by extensive infiltration with inflammatory cells. As a next time therapy
nilotinib was started. Symptoms of intolerance, which were observed initially, spontaneously resolved.
Complete cytogenetic remission and a higher molecular response (MR4.5) were achieved.
The patient remains under observation.