Allografting for Bosutinib, Imatinib, Nilotinib, Dasatinib, and Interferon Resistant Chronic Myeloid Leukemia without ABL Kinase Mutation

B Uz,O Bektas,O Ozcebe,H Goker,S Aksu,E Eliacik,I C Haznedaroglu,N Sayinalp,M Sayitoglu,Y Erbilgin,Y Buyukasik

doi:10.1155/2011/263725

B Uz, O Bektas + Show 9 more

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https://doi.org/10.1155/2011/263725

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Abstract

The current treatment of chronic phase chronic myeloid leukemia (CML) consists of oral tyrosine kinase inhibitors (TKIs). However, high-risk CML may present with an aggressive course which may result in blastic crisis or a “difficult-to-manage” state with available treatments. The aim of this paper is to report a patient with complicated CML resistant to treatment and progressed despite the administration of bosutinib, imatinib mesylate, nilotinib, dasatinib, interferon alpha 2a, cytotoxic chemotherapy, and allogeneic hematopoietic stem cell transplantation. The striking point of this case story is that no Abl kinase domain mutation against TKIs has been detected during this very complicated disease course of CML. Meanwhile, challenging cases will always be present despite the hope and progress in CML in the TKI era.

Highlights

chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder with bone marrow myeloid cell expansion [1] and peripheral leukocytosis [2]
The aim of this paper is to report a complicated CML patient which is resistant to treatment and progressed despite the administration of bosutinib, imatinib mesylate, nilotinib, dasatinib, aIFN, cytotoxic chemotherapy, and allo-HSCT (Table 1)
We described an aggressive course of CML progressed despite the administration of almost all available tyrosine kinase inhibitors (TKIs), namely, bosutinib, imatinib mesylate, nilotinib, and dasatinib

Summary

Introduction

CML is a clonal myeloproliferative disorder with bone marrow myeloid cell expansion [1] and peripheral leukocytosis [2]. The historical treatment agenda for CML includes cytotoxic chemotherapy, a-interferon (aIFN), allogeneic hematopoietic stem cell transplantation (allo-HSCT) [8], imatinib mesylate, and second-generation tyrosine kinase inhibitors (dasatinib and nilotinib) [1, 3, 8,9,10]. Alternative drugs are needed for the patients with imatinib-resistant CML or intolerant to imatinib and second-generation TKIs. Bosutinib (SKI-606) is a dual Src/Abl TKI with potent preclinical BCRABL inhibitory activity in imatinib-resistant CML cell lines [12, 13]. The aim of this paper is to report a complicated CML patient which is resistant to treatment and progressed despite the administration of bosutinib, imatinib mesylate, nilotinib, dasatinib, aIFN, cytotoxic chemotherapy, and allo-HSCT (Table 1)

Case Reports in Hematology

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