NILOTINIB TREATMENT IN IMATINIB-RESISTANT PEDIATRIC CHRONIC MYELOID LEUKEMIA
Mururul Aisyi,Nur Asih,Rizka Andalusia,Agus Kosasih
Pediatric Hematology Oncology Department Indonesian NCC Dharmais Cancer Hospital Pediatric Hematology Oncology Department Indonesian NCC Department of Pharmacy Indonesian NCC Clinical Pathology Department Indonesian NCC
Background : Chronic myeloid leukemia (CML) was a rare hematopoietic malignancy of pediatric and adolescent leukemia. It was challenging to defined the best therapeutic option because the specific guidelines for CML treatment in children have yet to be determined. There were two types of tyrosine kinase inhibitors (TKIs) frequently used in CML, imatinib as the approved treatment for CML in the pediatric and nilotinib as the second-generation of TKIs. Those TKIs have side effects in hematological and molecular responses. Patients who resistant or intolerance to imatinib could be treated to nilotinib. We reported a patient with imatinib-resistant CML treated with nilotinib at Pediatric Hematology Oncology Department National Cancer Hospital
Case Presentation Summary : A 17-year-old male BCR-ABL positive CML presented with imatinib mesylate resistant after previous 4 years of treatment. At the beginning he responds well to imatinib therapy. On admission, his left neck was swollen. There was hepatosplenomegaly and leukemia cutis. The routine laboratory investigations showed hyperleucocytosis. Bone marrow aspiration showed relapse CML with blast crisis. BCR-ABL/ ABL ratio was 69.37% IS. Nilotinib treatment was started at a dose of 200 mg with 2 tablets twice daily. The patient, recovered from the blast crisis of CML after 2 weeks of nilotinib administration. However, he also showed thrombocytopenia and leucopenia after 2 weeks administration, so the dose reduced to 150 mg once daily. After 1 month therapy, clinical and laboratory findings were stable. BCR-ABL/ABL ratio was reduced to 7.91% IS.
Learning Points/Discussion : Nilotinib was more effective in inhibiting BCR-ABL in the patient who has imatinib resistant. It can be used in blast crisis phase of CML but has severe bone marrow suppression side effect especially leucopenia and thrombocytopenia. The patient should be carefully monitored and appropriate dose change is important.
Keywords: Nilotinib children imatinib-resistant CML
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