Is it possible to discontinue imatinib mesylate therapy in Chronic Myeloid Leukemia patients with undetectable BCR/ABL? A case report and a review of the literature
Introduction
Nowadays imatinib mesylate (IM) is the standard first line therapy in patients with Chronic Myeloid Leukemia (CML) in chronic phase, and recent studies report 75–90% of Complete Cytogenetic Response (CCyR) [1], [2]. IM has shown to be more effective than interferon-α (IFN-α) and low-dose cytarabine (ARA-C) [3] and it is the best non-transplant treatment to date [4], [5]. To date, the effects of IM discontinuation in patients who achieve complete molecular response (CMR) are still unknown. We report the case of a patient who discontinued IM over a period of 15 months after achieving CMR.
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Case report
A 20-years-old male presented as outpatient because of hyper-leukocytosis. Personal and family history was not contributory. Physical examination revealed splenomegaly, with spleen palpable 5 cm below the left costal margin. Hepatomegaly and lymphoadenomegaly were not found. Complete blood cell count (with differential) showed 138.6 × 109 L−1 WBC, 427 × 109 L−1 platelets and haemoglobin 11.9 g/dl. Serum clinical chemistry values were within normal ranges, except for high serum levels of LDH (2804 U/L;
Discussion
To date the consequences of IM discontinuation are unknown. A few studies have been reported, with a relatively small number of patients discontinuing IM. The largest study, with twelve cases, was made by Rousselot et al. [6].
Higashi et al. [7] reported 2 patients in hematologic remission prior stopping imatinib mesilate. They developed blast crisis 13 and 14 days after IM cessation, respectively. Okabe et al. [8], on the other hand, reported the first case of sustained CCyR for more than 3
Conflict of interest
The authors confirm that there are no conflicts of interest.
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