Abstract
Background aims. Dasatinib is a second-generation tyrosine kinase inhibitor (TKI) for use in patients who have developed resistance or clinical progression with imatinib. There are few cases described in the literature regarding the development of Philadelphia (Ph)-negative lymphoid blast crisis in patients with a complete cytogenetic response to TKI. Methods and Results. We report on the case of a chronic myeloid leukemia (CML) patient who developed a Ph-negative acute lymphoblastic leukemia (ALL) while in complete cytogenetic remission (CCyR) with dasatinib. With the diagnosis of Ph-negative ALL, the patient was started on prednisone and proceeded to autologous hematopoietic stem cell transplantation (ASCT) using cells collected during cytogenetic remission with imatinib. In the third month post-transplantation, the patient was started on nilotinib and the patient now has an excellent performance status, maintaining CCyR and major molecular response 1 year after the procedure. Conclusions. There are seven reports of patients with CML who have developed Ph-negative ALL, two of them while being treated with imatinib. In five of these, the karyotype was diploid, as in our patient. Our patient was successfully treated with prednisone and ASCT, and has been using nilotinib since then, maintaining a cytogenetic and molecular response.
Acknowledgments
The authors would like to thank Dr Brian Druker for his participation in the initial treatment of the patient, and the valuable information he provided about it.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.