A 60-year-old woman diagnosed with positive BCR-ABL CML in January 2010.
From diagnosis to April 2011, treatment with imatinib 400mg/day with acceptable tolerance (moderate symptoms of tiredness, tenderness and rapid swelling within a week) was given to the patient, who had a very common allergic reaction, pale face oedema and appearance
In April 2011, due to the progression of the molecular signal and the acquisition of the Y253F mutation in peripheral blood (PB) and bone marrow (BM), imatinib was suspected by dasatinib 100mg/day.
The Y253F mutation confers imatinib resistance, intermediate susceptibility to nilotinib and susceptibility to dasatinib.
The patient showed good clinical tolerance during treatment with dasatinib, except for persistent cough and asthenia, with a higher molecular response.
During treatment with dasatinib, the patient developed pancreatitis with blast crisis of the MO, with a diagnosis of lymphoid blast crisis and a T315I mutation was detected in the ABL kinase domain.
Once morphological remission of the blast crisis was achieved after administration of induction chemotherapy with vincristine, daunorubicin, steroids and intrathecal prophylaxis and given the prior exposure to imatinib and dasatinib, she decided to start treatment in September 2012.
Initially, the dose administered was 45mg/day, which had to be reduced to 30mg/day due to clinical intolerance, mainly musculoskeletal pain, asthenia and high blood pressure, which was adjusted for antihypertensive treatment.
Currently, the patient maintains complete molecular response with acceptable tolerance.
It has recently been evaluated in the pretransplant consultation of the Hematology Service for possibility of consolidation with allogeneic HSCT of unrelated donor, since there is no HLA compatible brother.
