Translate page

× To share and enhance best practice management of CML, experts and interested clinicians can discuss difficult or interesting CML cases here. Physicians submit a brief history of the patient and the case for discussion (no more than 200 words) by posting it in this forum ("New Discussion" button below). Please include the country of origin.

Each clinical case will be forwarded to the expert clinical panel for a brief independent response. Consideration should be given to patient confidentiality. Details that are not critical to the case can be changed to preserve anonymity. Please consider including your email with the case. This will not be posted on the website, but is useful should further details be requested by the moderator.

As a full clinical history is necessary for accurate comment, cases and comments on the Forum are ONLY ACCEPTED FROM PHYSICIANS. If individual patients have a specific question we encourage them to contact their healthcare provider. General questions can be emailed to info@cml-foundation.org.

DISCLAIMER: The iCMLf does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this Forum is solely at your own risk.

CML congenital cardiac lesions

More
6 years 3 months ago #1609 by 966076155
This is a 37-y-o patient with recently diagnosed CML EUTOS score low. She has a history of congental cyanotic cardiopathy that has been surgically corrected on 2 occasions. She has a complete AV block and is on furosemide 20mg/d, ramipril 5md/d and carbamazepine 400mg/d (this is due na epitlogenic focus after a TIA), and leads a normal life.
what is the best TKI to start treatment with? Bosutinib?
  • Jeff Lipton
  • Jeff Lipton's Avatar
6 years 3 months ago #1610 by Jeff Lipton
Replied by Jeff Lipton on topic CML congenital cardiac lesions
It is a good question, but some more information would be helpful. Does she have a pacemaker? Any history of pleural effusions post operatively? Any history of heart failure at this time? How does it manifest?
If there is no history of peripheral edema, my choice for first line therapy would actually be imatinib. Pleural inflammation in the past with surgery might put her at risk with Dasatinib. Her hypertension might get worse with Bosutinib. Since this is not vascular disease related cardiac problems, and if she otherwise has no other risk factors and she has a pacemaker, nilotinib would probably be my second choice after imatinib.


ORIGINAL CASE:
This is a 37-y-o patient with recently diagnosed CML EUTOS score low. She has a history of congental cyanotic cardiopathy that has been surgically corrected on 2 occasions. She has a complete AV block and is on furosemide 20mg/d, ramipril 5md/d and carbamazepine 400mg/d (this is due na epitlogenic focus after a TIA), and leads a normal life.
what is the best TKI to start treatment with? Bosutinib?
  • Andrija Bogdanovic
  • Andrija Bogdanovic's Avatar
6 years 3 months ago - 6 years 3 months ago #1611 by Andrija Bogdanovic
Replied by Andrija Bogdanovic on topic CML congenital cardiac lesions
hello, I would be quite conservative in this lady with congenital heart disease after double life saving surgery and AV block. I would consider slower move towards CML control, therefore even in case of some manifestations of her heart disease (peripheral edema, but she is on furosemide) I would start with imatinib standard dose especially EUTOS is low. It would help to have ELTS survival estimate as one of possible leads in choice, but dasatinib is not suitable due to open heart surgery and possible effusions, and similarly nilotinib with metabolic effects are not my choice in the moment. Both, dasa and nilo may have QT prolongation and in such a case many unusual things could happen by Marphy. It would be a problem if she needs second line treatment? Moreover I have checked with such treatment there would no significant interactions with TKI's at all.

ORIGINAL CASE:
This is a 37-y-o patient with recently diagnosed CML EUTOS score low. She has a history of congental cyanotic cardiopathy that has been surgically corrected on 2 occasions. She has a complete AV block and is on furosemide 20mg/d, ramipril 5md/d and carbamazepine 400mg/d (this is due na epitlogenic focus after a TIA), and leads a normal life.
what is the best TKI to start treatment with? Bosutinib?
Last edit: 6 years 3 months ago by Nicola.
  • manuel abecasis
  • manuel abecasis's Avatar
6 years 3 months ago - 6 years 3 months ago #1612 by manuel abecasis
Replied by manuel abecasis on topic CML congenital cardiac lesions
Dear Jeff,
Thank you for your comments.
She does have a pace-maker and had a history of heart failure NYHA class IV but no pleural effusions. I have reviewed the cardiac and vascular toxicities of both bosutinib and imatinib and I will go for Imatinib as you suggest.


ORIGINAL CASE:
This is a 37-y-o patient with recently diagnosed CML EUTOS score low. She has a history of congental cyanotic cardiopathy that has been surgically corrected on 2 occasions. She has a complete AV block and is on furosemide 20mg/d, ramipril 5md/d and carbamazepine 400mg/d (this is due na epitlogenic focus after a TIA), and leads a normal life.
what is the best TKI to start treatment with? Bosutinib?
Last edit: 6 years 3 months ago by Nicola.
  • manuel abecasis
  • manuel abecasis's Avatar
6 years 3 months ago #1613 by manuel abecasis
Replied by manuel abecasis on topic CML congenital cardiac lesions
Dear Dr Bogdanovic
Thank you for your comments.
She has a ELTS score of 0,6 that is low risk. I agree with you Imatinib is probably the TKI to start with.
Moderators: Nicolaarlene