Abstract
BCR-ABL tyrosine-kinase inhibitors are the first-line therapy for the majority of patients with chronic myelogenous leukemia (CML). Up to 20% of patients who have imatinib-treated CML in blast crisis (BC) experience a relapse in the central nervous system (CNS) due to the poor penetration of the drug by the blood-brain barrier. The present case reports a successful experience of using dasatinib-based combination therapy to treat a 22-year-old female who presented with initial symptoms of intermittent fever and easy bruising under the diagnosis of CML in BC. Although the patient eventually succumbed to profound sepsis, the CNS involvement was treated successfully using dasatinib-based combination therapy (cranial radiation and de-escalated intrathecal chemotherapy). This case demonstrates that dasatinib may be a viable option for those who are not medically fit for or are otherwise unwilling to receive high-dose chemotherapy. It appears that dose intensity is essential for optimal efficacy and should be maintained at 150 mg daily as far as possible.
Highlights
Chronic myeloid leukemia (CML) is a myeloproliferative disorder that is associated with a unique translocation of chromosomes 9 and 22, resulting in the so‐called Philadelphia chromosome (Ph)
The present study reports a successful experience of using dasatinib‐based combination therapy to treat central nervous system (CNS) involvement in a 22‐year‐old female with CML in blast crisis (BC)
One possibility may be the loss of CNS disease control with the lowering of the dasatinib dose
Summary
Chronic myeloid leukemia (CML) is a myeloproliferative disorder that is associated with a unique translocation of chromosomes 9 and 22, resulting in the so‐called Philadelphia chromosome (Ph). Up to 20% of patients who have imatinib‐treated CML in blast crisis (BC) or Ph+ acute leukemia experience a relapse in the central nervous system (CNS) [3,4] This is a challenging issue in the imatinib era, and is due to the poor penetration of the drug by the blood‐brain barrier (BBB) [4,5,6,7,8,9,10]. Clinical course of the present patient with Philadelphia chromosome‐positive chronic myelogenous leukemia and recurrent central nervous system relapse while undergoing dasatinib combination therapy (CSF blast image; stain, Diff-Quik; magnification, x400). DA, dasatinib; CNS, central nervous system; Ph+, Philadelphia chromosome-positive; BC‐CML, chronic myeloid leukemia blast crisis; ALL, acute lymphoblastic leukemia; AML, acute megakaryoblastic leukemia; RT, radiotherapy; IT, intrathecal chemotherapy; SCT, stem cell transplantation; NR, not reported; CR, complete remission; PD, progressive disease; HSCT, hematopoietic stem cell transplantation.
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