August  2024 - We are delighted to share the first case review in a new series dedicated to the treatment of pediatric CML (pCML) in low and middle-income countries (LMICs). This series aims to provide a comprehensive discussion of challenging pCML cases from various perspectives to enhance knowledge and improve patient outcomes.

The inaugural case in this series has been published by Roy Moulik N et al. in the July edition of Case Reports on Oncology Medicine as an open access publication. This landmark case discusses a 14-year-old boy from India diagnosed with CML complicated by priapism and loss of vision. The case was initially presented during our 2023 Regional Discussion Groups in South Asia, where it sparked insightful discussions on best practices in resource-limited settings.

Series of pediatric CML cases from LMICs – discussed by experts of the iCMLf

A 2023 survey on the management of pediatric CML in LMICs (Roy Moulik N et al. Pediatr Hematol Oncol, Jan 2024) shed light on patient, physician, and infrastructure challenges in LMICs, urging the need for context-specific recommendations, advocacy for continuous TKI access, and improvements in diagnostic resources.

In 2024 the iCMLf have developed a series of detailed case reports examining pediatric CML presentations from multiple expert viewpoints, including a pediatric hemato-oncologist in a high-income country (Professor Meinolf Suttorp), a pediatric hemato-oncologist in a low- and middle-income country (Dr Nirmalya Roy Moulik), an adult CML specialist (Professor Beppe Saglio), and the iCMLf’s program manager, Dr Arlene Harriss-Buchan. Together they emphasise the Foundation's role in enhancing CML care worldwide.

By publishing these cases, we aim to bridge knowledge gaps and foster a collaborative approach to overcoming the unique challenges of treating pediatric CML, particularly in resource-limited settings.

Case No. 1 – A boy presenting with priapism and loss of vision

Cases of Patients Treated in Countries With Limited Resources and Discussed by Experts of the International CML Foundation (iCMLf) – Case No. 1: A Boy Presenting With Priapism and Loss of Vision
Roy Moulik et al. Case Rep Oncol Med, July 2024 – open access publication

The first published case review describes the clinical journey of a 14-year-old boy from India, whose CML diagnosis was complicated by priapism and loss of vision due to hyperleukocytosis. The authors discuss the management strategies employed, the challenges faced in a resource-limited setting, and the outcomes achieved, providing valuable insights for clinicians worldwide.

The discussion focused on the following issues:

1. Management of hyperleukocytosis in pCML
2. What could have changed the severity of organ damage?
3. First TKI to use: Imatinib versus dasatinib/nilotinib?
4. What is an optimal follow-up strategy?

Our sincere thanks to all the authors for sharing their time and expertise.

Access the full publication here

Outlook on further pediatric CML cases publications from the LMICs

The next case publication will be presented by Professor Mariana Bohns Michalowski, from the Federal University of Rio Grande do Sul, Brazil. This upcoming report will discuss a pediatric CML case characterized by treatment suspension and persistent remission. Additionally, a third case in the series will come from Africa, further expanding our global perspective on pediatric CML management.

We’ll keep you informed about these case publications.

Role of the iCMLf in improved outcomes for pCML

This case review series underscores the imperative for the iCMLf’s endeavours in supporting and educating physicians treating pediatric CML in LMICs.

To support our mission, the iCMLf offers several resources focused on pediatric CML:

• A dedicated module on pediatric CML in the iCMLf Knowledge Centre
• A collection of resources on pediatric CML to guide clinical decision-making
• A Case Discussion Forum to discuss challenging cases on pediatric CML

We encourage the CML community to actively contribute to knowledge-sharing by submitting challenging pediatric CML cases on the Case Discussion Forum or by emailing info@cml-foundation.org