Efficacy of nilotinib in a young patient with high Sokal risk CML Ph+ in treatment failure after high dose imatinib

Abstract

This article describes the case of a 44 year old man, at high-risk according to the Sokal Index, after CML Ph+ diagnosis, started imatinib at the standard dose (400 mg/day). Initially he reached optimal response, but at month 12, because of a loss of cytogenetic response, he was documented as a treatment failure. The mutational screening revealed no mutations and the blood level testing (BLT) showed values of ​​lower limits, therefore he increased imatinib to 800 mg/day. This therapeutic choice did not result in the achievement of an optimal response and the imatinib compliance was deteriorated. So, after nearly 12 months of treatment with high dose imatinib, we considered the treatment as a failure, and he switched to nilotinib, at the dose of 800 mg/day. After only 3 months of treatment, he reached complete cytogenetic response (CCyR) and major molecular response (MMolR), which the patient continues to maintain, as documented by the recent evaluation at month 30.

Keywords

• CML
• High dose imatinib
• Nilotinib