The iCMLf recently hosted the second Regional Discussion Group for South Asia for 2024, focusing on complex cases and management strategies for CML. The Regional Discussion Group program is designed to provide a platform for physicians across low- and middle-income countries to interact with both international and regional CML experts. The session, held on May 29th, was marked by in-depth discussions and expert insights, particularly highlighting a challenging case presented by Professor Mehreen Ali Khan.

“I congratulate iCMLf for all the logistic and intellectual support for the service of humanity especially in our part of the world. Opinions of experts of world fame definitely taught us a lot. This is the first time in 25 years of my Hematology career that I have had such an opportunity. Thank you iCMLf.” - Professor Mehreen Ali Khan, Pakistan

A Complex Case of CML Transforming into Acute Leukemia

Professor Mehreen Ali Khan presented a particularly complicated case of a 31-year-old woman who was diagnosed with CML in 2014. Initially, the patient responded well to second-line therapy and achieved molecular remission. However, she relapsed post-pregnancy in 2016. An allogeneic bone marrow transplant in 2018 failed to prevent a subsequent relapse. By August 2023, the patient developed severe abdominal pain, which revealed extensive portal vein thrombosis and abdominal hemorrhage. This alarming development led to the discovery that the leukemia had transformed into acute leukemia.

The case discussion, led by Professor Mauro, involved the audience in deliberating potential next steps for this patient. The dialogue underscored the complexities and challenges of managing such a patient, particularly when dealing with relapses post-transplantation.

Challenges in Long-Term Treatment Management

The panel discussed various aspects of managing long-term treatment for CML patients, especially those who relapse post-transplantation. One of the critical points of discussion was the potential for treatment-related secondary leukemia and the intricate balance required between treatment duration and the patient’s wish to start a family.

The audience-driven debate also touched upon the cost-effectiveness of stamp inhibitors versus transplantation for patients with chronic phase CML and resistant disease. This included an examination of the complications that arise from long-term treatment, such as thrombosis and portal hypertension, and how these issues impact patient management.

Impact of Mutations and Long-Term Complications

Another significant part of the discussion was the impact of mutations on treatment. The experts acknowledged the challenges posed by mutations and how they influence the effectiveness of various treatment options. Complications like thrombosis and portal hypertension, which are associated with long-term CML treatment, were also examined in detail.

The session saw high engagement from the audience, with many questions directed at the panel regarding the discussed case and general CML management. The interactive nature of the discussion highlighted the global interest and the shared challenges faced by medical professionals in managing CML. 

We extend gratitude to all participants and panelists for their contributions to such a successful session, particularly Professor Gundeti and Professor Ali Khan, your time sourcing and presenting the cases for discussion is really appreciated, and Professor Mauro and Professor Chaudhri thank you for your advice and guidance during the conversations.

Highlights from the session are available to watch at our YouTube channel:

View part 1: The realities of long-term treatment

View part 2: The Role of Allogenic Stem Cell Transplant

Keep a look out for Latin America and Africa Regional Discussion Groups coming soon.

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