Case: A Younger Patient With Relapsed CML
May 2013
- A 48-year-old female was diagnosed with CP-CML with a splenomegaly, 3.2 cm below the costal margin
- Laboratory values:
- WBCs, 157,000/μL
- HCT, 30% hematocrit
- Platelets, 359,000/μL
- Myeloblasts, 6%
- Bone marrow biopsy: Ph+ in 20/20 metaphases
- Q-PCR, showed a BCR-ABL1/ABL1 ratio of 176%
- The patient was started on dasatinib 100 mg; she achieved MMR after 6 months, and a deeper molecular remission (>MR4) after 12 months on therapy and remained in remission for 3 years
December 2016
- The patient complained of increasing fatigue and weight loss.
- Q-PCR showed a significant increase in BCR-ABL1 transcript ratio (to 50% IS)
- Bone marrow biopsy; 80% cellularity, 18/20 Ph+ metaphases
- Mutation testing showed the presence of T315I
- CBC WNL
- The patient was started on ponatinib 45 mg daily
- She developed grade 3 thrombocytopenia; the ponatinib dose was reduced to 30 mg daily
March 2017
- Cytogenetics, 3/20 Ph+ metaphases
- BCR-ABL1 transcript ratio, 5%
June 2017
- BCR-ABL1 transcript ratio, 0.75%.
October 2017
- BCR-ABL1 transcript ratio, 0.01% and no T315I mutation was detected