Imatinib
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Development of resistance in chronic myeloid leukaemia: case report A 19-year-old woman developed resistance to imatinib [Glivec] during treatment for chronic myeloid leukaemia (CML). After presentation in August 2003, the woman was diagnosed with Philadelphia chromosome-positive CML in chronic phase; her karyotype was 46,XX,t(9;22)[n = 20 metaphase cells]. At her presentation in November 2005, her treatment was stated as imatinib 200 mg/day for 12 months overall [route not stated]. At her presentation in November 2006, her treatment was stated as imatinib 400 mg/day for 12 months overall. At her presentation in November 2008, her treatment was stated as imatinib 400 mg/day for 12 months overall "in the total", that she had interrupted treatment for about 12 months, and that nilotinib was started in November 2009. Her WBC count was 15.5 x 109/L, her platelet count was 215 x 109/L and her hemoglobin level was 8.8 g/dL. Her karyotype was 45,XX,t(9;22),+dic(17;18),-17,-18[20] with b2a2 transcript and T315I mutation. At her presentation in March 2010, her treatment was stated as nilotinib 800 mg/day for 5 months overall. Her WBC count was 2.2 x 109/L, her platelet count was 111 x 109/L and her haemoglobin level was 9.5 g/dL. Her karyotype was 45,XX,t(9;22),+dic(17;18),-17,-18[16]/46,XX,t(9;22)[4], with co-expression of b2a2 and b3a2 transcript and T315I mutation. She died in November 2010 [cause of death not stated]. Author comment: "Here we reported a novel case of a Ph chromosome positive CML with dic(17;18), loss of TP53 gene, co-expression of b2a2 and b3a2 fusions transcript and T315I mutation resulting in Glivec resistance, while good response in nilotinib was observed; i.e. the clone with the dicentric chromosome decreased under this treatment from 100% to 80%." Al-Achkar W, et al. A novel dic (17;18) (p13.1;q11.2) with loss of TP53 and BCR/ ABL rearrangement in an imatinib resistant chronic myeloid leukemia. Molecular Cytogenetics 5: [6 pages], No. 36, 2012. Available from: URL: http:// 803080930 dx.doi.org/10.1186/1755-8166-5-36 - Syria
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Reactions 15 Dec 2012 No. 1432
