Successful Third Hematopoietic Stem Cell Transplantation for Blast Crisis of Chronic Myeloid Leukemia After Two Times of Graft Failure
Chronic Myelogenous Leukemia is a myeloproliferative disorder characterized by the
existence of Philadelphia chromosome. BCR-ABL protein targeted drugs called tyrosine kinase
inhibitors dramatically improved patients’ survival in 2010s.
These drugs are imatinib, Nilotinib, Dasatinib and Radotinib.
As a result, hematopoietic stem cell transplantation
(HSCT) with allo-HSCT is decreasing.
A graft failure is one of the crucial complications in allo-HSCT. If it occurs, the most of
the patients run their fatal course. In the present case, promyelocytic blast crisis
occurred in the second chronic phase CML and we performed allo-HSCT
for three times for graft failures.
A 42 year-old male was diagnosed with CML in June 2011 and started
the administration of nilotinib of 600 mg/day on June 12, 2011.
He was treated by TKI, and a month later, therapeutic
effect reached complete hematologic response.
Then, 5 months later, it reached complete cytogenetic response although it had
never reached major molecular response ever.
We considered changing nilotinib to dasatinib at the 19th month since it did not
reach major molecular response at the
18th month. On January 20, 2013, laboratory data showed pancytopenia;
white blood cell count of 1.76×109 /L, hemoglobin
count of 14.6 g/dL and platelet count of 122.0×109 /L.
Biochemical testing showed asparatate transaminase at 33 U/L,
alanine aminotransferase at 218 U/L, lactate dehydrogenase
at 148 U/L, total bilirubin at 2.3 mg/dL and CReactive Protein at 0.05 mg/dL.
Coagulation test showed prothrombin time -INR at 0.96, activated partial
thromboplastin time at 27.4 sec, fibrinogen at 212 mg/dL, fibrin/fibrinogen
degradation product (FDP) 1.6 µg/mL.
Intern Med Open J. 2017; 1(1): 13-19. doi: 10.17140/IMOJ-1-104