open access

Vol 9, Supp. A (2018)
Case report
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Nilotinib treatment of a patient with chronic myelogenous leukemia after previous failure to imatinib and dasatinib

Marzena Wątek1, Ewa Wasińska1, Sylwia Kościołek-Zgódka1, Marcin Pasiarski1, Stanisław Góźdź1
DOI: 10.5603/Hem.2018.0010
Affiliations
  1. Klinika Hematologii i Transplantacji Szpiku, Świętokrzyskie Centrum Onkologii, ul. Artwińskiego 3, 25–734 Kielce, Poland

open access

Vol 9, Supp. A (2018)
CASE REPORTS

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.

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.

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Keywords

chronic myelogenous leukemia, treatment, nilotinib

About this article
Title

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

Journal

Hematology in Clinical Practice

Issue

Vol 9, Supp. A (2018)

Article type

Case report

Pages

9-14

Page views

219

Article views/downloads

439

DOI

10.5603/Hem.2018.0010

Keywords

chronic myelogenous leukemia
treatment
nilotinib

Authors

Marzena Wątek
Ewa Wasińska
Sylwia Kościołek-Zgódka
Marcin Pasiarski
Stanisław Góźdź

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