Efficacy of nilotinib in a patient in late chronic phase CML, intolerant to imatinib and resistant to dasatinib

Abstract

We describe the case of a 60-year-old woman who was admitted to our hospital in 1999. A blood test performed for pain in the upper left side of the abdomen had showed leukocytosis. At the admission the patient was apyretic, with no systemic signs. An important splenomegaly was found at physical examination. The results of the bone marrow aspiration (hypercellularity) and the cytogenetic analysis (chromosoma Ph in all metaphasis) allowed us to diagnose CML. The patient’s Sokal score was high (1.252). The patient was treated with hydroxyurea until 2002, when imatinib became available. Then she started imatinib at the dosage of 400 mg/die. Tests performed during the follow up showed a fast haematological response but no cytogenetic response in two years. The patient received imatinib until February 2004, when a psoriasiform-lichenoid dermatosis appeared. Therefore we decided to interrupt the therapy and the skin lesions disappeared. After starting again imatinib, also dermatosis reappeared, so we decided to interrupt imatinib definitively. On July 2007 the patient started dasatinib, a 2nd generation TKI. No adverse events occurred and cytogenetic analysis performed periodically was always positive (no response). She continued on dasatinib until May 2010, when she switched to nilotinib. In seven months a complete cytogenetic response (CCyR) was documented with level reduction of Bcr Abl transcript from 13.0 to 2.0. Currently the patient is still receiving nilotinib, with persistent CCyR.