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K245N mutation

  • Susanne Saussele
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2 years 3 weeks ago #1888 by Susanne Saussele
K245N mutation was created by Susanne Saussele
Male patient, 50 years old at diagnosis, CML since 11/2019, initial CP, Ph pos, typical transcript, no comorbidities.

Started with nilotinib treatment 11/2019, BCR >1% after 1 Year (3.5%), Dasatinib not tolerated, switch to ponatinib 30mg 1/21 (within a study) increased to 45 mg 6/21 (BCR-ABL 0.5%)

As the BCR::ABL1 level increased in March this year (0.6%) a mutational analysis was performed in 2 labs . One lab detected the K245N mutation.

Since then BCR:ABL1 decreased to 0.2% but is stable for 3 months now, still no MMR.

We recommended an allo SCT as the mutation appeared. But only one donor with mismatch was detected. One son (17 years old) could be a haplo donor.

Patient’s wish is to try asciminib.

What would you do?
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  • Delphine Rea
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2 years 3 weeks ago - 2 years 3 weeks ago #1889 by Delphine Rea
Replied by Delphine Rea on topic K245N mutation
This mutation is not well know.

Whether asciminib would be efficient is uncertain due to lack of data.

Vodobatinib in trial may also be attempted but again, no set of data against this mutation.

I would not transplant.

I would try to know what is the size of the mutated clone by ngs. I may maintain pona provided stability of mrd ... and change upon increase. Difficult indeed.

Best regards,

Delphine
Last edit: 2 years 3 weeks ago by arlene.
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