Complete molecular response induced by nilotinib in a patient previously treated with imatinib, nilotinib and dasatinib

Abstract

We reported a case report of a female patient with chronic myeloid leukemia who was treated with nilotinib after failure to imatinib, nilotinib, dasatinib. The patient was diagnosed in 2001 and treated with imatinib, but complete cytogenetic response (CCyR) and complete hematologic response (CHR) were lost four years later. Doubling imatinib dose to 800 mg/die gave no positive results. The patient was enrolled in clinical trial with nilotinib, but mutational analysis performed after two months showed Y253H point mutation (no nilotinib sensitive). In April 2007 dasatinib was started and CCyR and major molecular response (MMolR) was reached. In May 2011 Bcr-Abl transcript progressively increased and mutational analysis showed a M244V point mutation. Therapy with nilotinib 800 mg/die was started, and after six months the patient obtained a complete molecular response (CMR), surprising with disappearance of both point mutations.