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.
Keywords: chronic myelogenous leukemiatyrosine kinase inhibitorsimatinibdasatinibnilotinibinterferon alphatoxicitytreatment failure