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Case study with dazatinib anhydrous

  • Zuzana Sninska
  • Zuzana Sninska's Avatar Topic Author
1 week 6 days ago - 18 hours 20 minutes ago #2011 by Zuzana Sninska
Case study with dazatinib anhydrous was created by Zuzana Sninska
Location: Slovakia

46 years old patient was diagnosed with CML in CP in February 2024. His blood count was typical with leucocythosis of 41.8 x109/l with left shift, normal hemoglobin (144 g/l) and platelet level (266 x109/l). His risk score was low according to Sokal (0,6) and ELTS (1,07). He had typical cytogenetic finding: 46,XY,t(9,22)(q34,q11) [20], FISH: bcr::abl pozit. 96%, and typical transcript b2a2. In his medical history was asthma bronchiale and gastroezophageal reflux. His concomitant medication was ipratropium, antihistaminica and pantoprazol (PPI) as needed.

After initial cytoreductive treatment the question was, what´s the goal of the treatment: to prolong overall survival or to achieve treatment free remission? In this relatively young patient we decided to achieve treatment free remission, therefore he started treatment with second generation TKI - dazatinib anhydrous in a dose of 79mg since 21.3.2024. After 3 months of treatment, he achieved optimal cytogenetic and molecular response, his bcr::abl level decreased below 10%, after 6 months his bcr::abl level was below 1% and after 9 months he achieved major molecular response. He had no adverse events during treatment.

How long should TKI treatment last after achieving MR4 or MR4.5 before discontinuation?
Last edit: 18 hours 20 minutes ago by arlene.
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  • Susanne Saussele
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18 hours 23 minutes ago - 18 hours 19 minutes ago #2016 by Susanne Saussele
Replied by Susanne Saussele on topic Case study with dazatinib anhydrous
The general recommendation from NCCN and ELN is for an optimal TFR attempt to have at least 5 year treatment of TKI of which 2-3 years should be in DMR. However, in case of adverse treatment the minimum criteria can be discussed in such a patient which should be 3 years of TKI with 1 year minimum in MR4. The chance to stay in TFR is raising then each year by approx 3%/year.

So for this patient I would recommend to switch TKI as dasatinib is probably not the best in COPD patients . An alternative would be bosutinib nilotinib or imatinib. I would go for TFR in this patient.
Last edit: 18 hours 19 minutes ago by arlene.
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