Abstract
For patients with chronic myeloid leukemia (CML) failing imatinib therapy, second-generation tyrosine kinase inhibitors (TKIs) are recommended. Here, we describe two patients with advanced CML who failed imatinib therapy and did not tolerate the recommended dose of dasatinib, but then achieved a major molecular response with the combination of imatinib and dasatinib with no significant extramedullary toxicity. Our observations suggest that combination of TKIs may provide an additive/synergistic antileukemic effect.
Highlights
Imatinib is the frontline therapy for chronic-phase chronic myeloid leukemia (CML) because it demonstrates high complete cytogenetic response (CCyR) and major molecular response (MMR) rates
In advanced-phase CML, 38% of the patients treated with imatinib achieved major cytogenetic response (MCR)[3]
For patients with CML who become or are inherently resistant to imatinib therapy, dose escalation and the second-generation tyrosine kinase inhibitors (TKIs) need to be considered based on the BCR-ABL mutation profile and the patient’s disease history[4], with the notable exception of the T315I mutation
Summary
Imatinib is the frontline therapy for chronic-phase chronic myeloid leukemia (CML) because it demonstrates high complete cytogenetic response (CCyR) and major molecular response (MMR) rates. Dasatinib and nilotinib are potent tyrosine kinase inhibitors (TKIs) with activity against many imatinib-resistant CML clones. For patients with CML who become or are inherently resistant to imatinib therapy, dose escalation and the second-generation TKIs need to be considered based on the BCR-ABL mutation profile and the patient’s disease history[4], with the notable exception of the T315I mutation.
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