We are pleased to share the second publication in our ongoing series of pediatric CML (pCML) case reviews from low and middle-income countries (LMICs). These cases reflect the complexities inherent in managing pCML in resource-limited settings and aim to provide a comprehensive discussion from various perspectives to enhance knowledge and improve patient outcomes.

The latest case, published in the March edition of Case Reports in Oncology Medicine, highlights a challenging case from Brazil. Experts discuss treatment discontinuation in a child with CML who has not achieved a sustained deep molecular response.

A multi-perspective review of pediatric CML cases from LMICs

This case, like others in the series of detailed case reports from LMICs featured by the iCMLf, is reviewed through the lens of global CML experts including: 

• Professor Meinolf Suttorp, Germany – Pediatric hemato-oncologist
• Dr. Mariana Bohns Michalowski, Brazil – Pediatric hemato-oncologist
• Professor Beppe Saglio – Adult CML specialist
• Dr. Arlene Harriss-Buchan – iCMLf Program Manager

Their discussion offers nuanced perspectives on the clinical decision-making involved, the challenges posed by healthcare disparities, and the surprising clinical trajectory of this young patient.

Case No. 2 – Treatment discontinuation with ongoing remission in pediatric CML

Cases of patients treated in countries with limited resources and discussed by experts of the International CML Foundation (iCMLf) – Case No. 2: Treatment-free remission after 9 years of imatinib treatment without prior achievement of sustained deep molecular response
Bohns Michalowski M et al. Case Rep Oncol Med, March 2025 – open access publication

This case describes a 9-year-old boy from Brazil who, despite not reaching sustained deep molecular response (DMR), stopped imatinib after 9 years due to socioeconomic challenges and has maintained DMR and treatment-free remission for 24 months.

The case opens an important expert dialogue around:

1. Optimal dosing strategies and PCR monitoring intervals in pediatric CML
2. Feasibility of treatment-free remission without sustained DMR
3. Biological factors contributing to treatment-free remission in pediatric patients
4. Risks associated with limited molecular follow-up
5. Resources available from the iCMLf to assist treatment challenges in children with CML

We thank the authors for their valuable contribution and dedication to advancing pediatric CML care.

Access the full publication here

What’s next in the series?

A third case from Africa will be published this year, providing further global insights into pediatric CML management in challenging environments.

Supporting the global pediatric CML community

This case series underscores the iCMLf's commitment to knowledge-sharing and capacity building to overcoming the unique challenges of treating pediatric CML in LMIC's. 
Explore our current educational resources with more to come this year:

• Pediatric CML module in the iCMLf Knowledge Centre
• Curated pediatric CML resources for clinicians
• CML Case Discussion Forum to discuss challenging cases on pediatric CML

Do you have a challenging pediatric CML case you'd like to share? Please connect with us via the Case Discussion Forum at info@cml-foundation.org