Philadelphia-negative acute lymphoblastic leukemia in a chronic myeloid leukemia patient receiving dasatinib

• Published in: Cytotherapy (Oxford, England) Vol. 12; no. 1; pp. 113 - 115
• Main Authors: Santos, Fabio P.S, Rodrigues, Morgani, Mac-Donald Bley do Nascimento, Claudia, Kerbauy, Fábio R, Ribeiro, Andreza Alice Feitosa, Mauro Kutner, José, Hamerschlak, Nelson
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 2010; Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS)
• Subjects: Advanced Basic Science; Aged; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; BCR-ABL-negative atypical chronic myeloid leukemia; Benzamides; Blast Crisis - chemically induced; Blast Crisis - immunology; Blast Crisis - physiopathology; Dasatinib; Hematopoietic Stem Cell Transplantation; Humans; Iatrogenic Disease - prevention & control; imatinib; Imatinib Mesylate; Immunosuppressive Agents - therapeutic use; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - immunology; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - physiopathology; Male; Middle Aged; Other; Piperazines - pharmacology; Piperazines - therapeutic use; Precursor Cell Lymphoblastic Leukemia-Lymphoma - chemically induced; Precursor Cell Lymphoblastic Leukemia-Lymphoma - immunology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - physiopathology; Prednisone - therapeutic use; Protein Kinase Inhibitors - adverse effects; Protein Kinase Inhibitors - therapeutic use; Pyrimidines - adverse effects; Pyrimidines - pharmacology; Pyrimidines - therapeutic use; Remission Induction - methods; Thiazoles - adverse effects; Thiazoles - therapeutic use; Treatment Outcome; imatinib; BCR-ABL-negative atypical chronic myeloid leukemia; dasatinib
• ISSN: 1465-3249; 1477-2566
• DOI: 10.3109/14653240903300666

Background aims Dasatinib is a second-generation tyrosine kinase inhibitor (TKI) for use in patients who have developed resistance or clinical progression with imatinib. There are few cases described in the literature regarding the development of Philadelphia (Ph)-negative lymphoid blast crisis in patients with a complete cytogenetic response to TKI. Methods and Results We report on the case of a chronic myeloid leukemia (CML) patient who developed a Ph-negative acute lymphoblastic leukemia (ALL) while in complete cytogenetic remission (CCyR) with dasatinib. With the diagnosis of Ph-negative ALL, the patient was started on prednisone and proceeded to autologous hematopoietic stem cell transplantation (ASCT) using cells collected during cytogenetic remission with imatinib. In the third month post-transplantation, the patient was started on nilotinib and the patient now has an excellent performance status, maintaining CCyR and major molecular response 1 year after the procedure. Conclusions There are seven reports of patients with CML who have developed Ph-negative ALL, two of them while being treated with imatinib. In five of these, the karyotype was diploid, as in our patient. Our patient was successfully treated with prednisone and ASCT, and has been using nilotinib since then, maintaining a cytogenetic and molecular response.