Oncology Case Challenge: A 46-Year-Old Mother With Severe, Constant Abdominal Pain

Mounika Gangireddy, MD, MBBS


April 13, 2022

The toxicity profiles of all the TKIs are similar. The most common toxicities are hepatotoxicity, cardiotoxicity, pleural effusion, myelosuppression, and QT prolongation.

Allogeneic stem cell transplant is used for salvage in patients with CML-CP whose disease has progressed on more than two TKIs. The cure rates with allogeneic stem cell transplant are about 15%-40% for CML-AP and 10%-20% for CML-BP.[19]

The response to treatment can be monitored with chromosome analysis, FISH, and PCR. PCR is the most sensitive and evaluable test and predicts relapse.[20,21,22,23]

A complete hematologic response is defined as a WBC count < 10 × 109/L, a platelet count < 450 × 109/L, no blasts, basophils < 20%, and no extramedullary involvement.

A cytogenetic response is determined by analyzing all 20 chromosomes. A complete cytogenetic response is defined as none of the metaphases having the Ph chromosome, a partial cytogenetic response indicates that 1%-35% of the metaphases harbor the Ph chromosome, and a minor cytogenetic response indicates that 36%-95% of the metaphases have the Ph chromosome.

A molecular response is determined by BCR-ABL reverse transcription–PCR analysis. A major molecular response (MMR) is classified into MR3, MR4, MR4.5, and undetectable based on the log findings on PCR. These are defined as < 0.1, < 0.01, < 0.0032, and 0 respectively.

The European LeukemiaNet guidelines and the National Comprehensive Cancer Network Clinical Practice Guidelines recommend performing chromosome analysis, FISH (in Ph-CML), and PCR at diagnosis followed by every 3 months.[8,10] Continue PCR every 3 months until 2 years after the BCR-ABL is < 1% (international scale) and then every 3-6 months. Repeat PCR in 1-3 months if there is a 1-log increase in a patient with an MMR.[24]

This patient started the second-generation TKI dasatinib at a dosage of 140 mg/d. At 3 months, she is in complete hematologic response, with a BCR-ABL < 0.1% (MMR).


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