International Journal of Hematology

, Volume 107, Issue 4, pp 495–497 | Cite as

Sudden blast phase in chronic myeloid leukemia developed during nilotinib therapy after major molecular response was achieved

  • Yosuke Okada
  • Ken Sato
  • Shinichi Kobayashi
  • Shigeki Nagao
  • Kosuke Takano
  • Masahiro Teramoto
  • Noriaki Tachi
  • Toshikuni Kawamura
  • Toshikatsu Horiuchi
  • Shoichiro Kato
  • Reina Saga
  • Takaaki Maekawa
  • Takeshi Yamamura
  • Junichi Watanabe
  • Ayako Kobayashi
  • Fumihiko Kimura
Case Report
  • 244 Downloads

Abstract

Sudden blast phase (SBP) is a rare event in which patients with chronic myeloid leukemia (CML) in complete cytogenetic response (CCyR) rapidly progress to the blast phase. Few patients on second-generation tyrosine kinase inhibitors (2nd TKIs) have been reported to develop SBP. Here, we report a 45-year-old man diagnosed with CML in the chronic phase in April 2008 and immediately started on imatinib therapy. He achieved CCyR 12 months after starting imatinib therapy. Imatinib was followed by treatment with the 2nd TKIs nilotinib and dasatinib from January 2011 to yield a better response. He achieved major molecular response (MMR) during dasatinib therapy in February 2012, but did not tolerate dasatinib well; hence, he was switched to nilotinib in July 2012. In December 2015, he presented at our hospital with fever and lumbago. A complete blood count revealed a white blood cell count of 30,500/µL with 60% blasts, leading to diagnosis of SBP. After dasatinib therapy and conventional chemotherapy, he again achieved MMR. This case demonstrates that SBP may occur after achieving MMR on treatment with 2nd TKIs. Continuous careful monitoring is required for the early detection of SBP, even in patients who have achieved MMR.

Keywords

Chronic myeloid leukemia Sudden blast phase Nilotinib Dasatinib Major molecular response 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Cortes J, Kantarjian H. How I treat newly diagnosed chronic phase CML. Blood. 2012;120:1390–7.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kantarjian H, Cortes J. New strategies in chronic myeloid leukemia. Int J Hematol. 2006;83:289–93.CrossRefPubMedGoogle Scholar
  3. 3.
    Kantarjian H, O’Brien S, Cortes J, Giles F, Thomas D, Kornblau S, et al. Sudden onset of the blastic phase of chronic myelogenous leukemia: patterns and implications. Cancer. 2003;98:81–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Jabbour E, Kantarjian H, O’Brien S, Rios MB, Abruzzo L, Verstovsek S, et al. Sudden blastic transformation in patients with chronic myeloid leukemia treated with imatinib mesylate. Blood. 2006;107:480–2.CrossRefPubMedGoogle Scholar
  5. 5.
    Tantiworawit A, Power MM, Barnett MJ, Hogge DE, Nantel SH, Nevill TJ, et al. Long-term follow-up of patients with chronic myeloid leukemia in chronic phase developing sudden blast phase on imatinib therapy. Leuk Lymphoma. 2012;53:1321–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Alimena G, Breccia M, Latagliata R, Carmosino I, Russo E, Biondo F, et al. Sudden blast crisis in patients with philadelphia chromosome-positive chronic myeloid leukemia who achieved complete cytogenetic remission after imatinib therapy. Cancer. 2006;107:1008–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Angelopoulou MK, Asimakopoulos JV, Galani Z, Levidou G, Roumelioti M, Vassilakopoulos TP, et al. Extramedullary sudden blast crisis in chronic-phase chronic myeloid leukemia during first-line treatment with nilotinib. Blood Cancer J. 2016;6:e461.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Shet AS, Jahagirdar BN, Verfaillie CM. Chronic myelogenous leukemia: mechanisms underlying disease progression. Leukemia. 2002;16:1402–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Baccarani M, Deininger MW, Rosti G, Hochhaus A, Soverini S, Apperley JF, et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013;122:872–84.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Breccia M, Alimena G. The significance of early, major and stable molecular responses in chronic myeloid leukemia in the imatinib era. Crit Rev Oncol Hematol. 2011;79:135–43.CrossRefPubMedGoogle Scholar
  11. 11.
    Hehlmann R, Muller MC, Lauseker M, Hanfstein B, Fabarius A, Schreiber A, et al. Deep molecular response is reached by the majority of patients treated with imatinib, predicts survival, and is achieved more quickly by optimized high-dose imatinib: results from the randomized CML-study IV. J Clin Oncol. 2014;32:415–24.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2017

Authors and Affiliations

  • Yosuke Okada
    • 1
  • Ken Sato
    • 1
  • Shinichi Kobayashi
    • 1
  • Shigeki Nagao
    • 1
  • Kosuke Takano
    • 1
  • Masahiro Teramoto
    • 1
  • Noriaki Tachi
    • 1
  • Toshikuni Kawamura
    • 1
  • Toshikatsu Horiuchi
    • 1
  • Shoichiro Kato
    • 1
  • Reina Saga
    • 1
  • Takaaki Maekawa
    • 1
  • Takeshi Yamamura
    • 1
  • Junichi Watanabe
    • 1
  • Ayako Kobayashi
    • 1
  • Fumihiko Kimura
    • 1
  1. 1.Division of Hematology, Department of Internal MedicineNational Defense Medical College HospitalTokorozawaJapan

Personalised recommendations