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MDS 10 years after CCR three years after MMR >4

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10 years 9 months ago #515 by aliciama@mednet.org.uy
MDS 10 years after CCR three years after MMR >4 was created by aliciama@mednet.org.uy
63 yo now. CMLL diagnosed 2001. IF and shorts periods of Cytarabine. Never under ITK for patients election. CCR for years CMM>4 in the last two years. Very low IF dose 5Mu/week till suspended an year ago. Anemia and leucopenia with chronic neutropenia we believed 2dary to IF. Last cytogenetic Apil 2011 no CR Phi no other translocations. As the bicytopenia persisted far from If we performed a new cytogenetic with no CrPHi(CrPHi negative en 27 metaphases) but 5q-, 7q- and many other chromosome alterations (complex cariotype)+ severe myelodisplasia in all three myelods lienages by marrow aspiration. Now appear bcr/abl RTPCR >2. Never was under ITK. She has an BMsibling of 67 now identified when she began with her CML more than 10 years ago.
Should I considere this MDS 2ndary to her CML which appear to be present a molecular level? Could If had produced those changes? Thank you for your answer
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  • Giuseppe Saglio
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10 years 8 months ago #527 by Giuseppe Saglio
Replied by Giuseppe Saglio on topic Re: MDS 10 years after CCR three years after MMR >4
Very interesting case in which a CML responding well to IFN therapy is associated with an MDS with a complex karyotype. Although some data are missing to calculate R-IPSS precisely, the patient should fall into the poor or very poor risk category and therefore considering the risk, the age and the possible availability of a sibling donor, if no other contraindications are present, I would switch the patient to SCT (also UBMT if the sister is not compatible). The 5q- abnormality could support the use of lenalidomide, although the complex caryotype decreases the probability of a good response to this therapy. Finally the option of some cycles with Azacytidine has to be considered, in particular as a preparative regimen to induce remission in view of the transplant procedure. The problem of this patient is not CML, but MDS and this is not due to IFN or CML, but probably to environmental or occupational exposure to genotoxic agents that were likely to be the cause for both, MDS and CML.
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10 years 8 months ago #528 by jeff
Replied by jeff on topic Re: MDS 10 years after CCR three years after MMR >4
Agree with Dr Saglio about allografting. Would not delay as this patient can and likely will become leukemic making transplant results poorer. I am not sure that any treatment preallograft will improve the outcome. Although technically this MDS may not be due to the IFN therapy and not due to previous CML, it is considered secondary and is bad risk.
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10 years 8 months ago #529 by aliciama@mednet.org.uy
Replied by aliciama@mednet.org.uy on topic Re: MDS 10 years after CCR three years after MMR >4
We are asking ofr here 6 cures of 5 azacetidyne. We are allitle afrai with the transplantation issue becuse of he age. In the case of BMT we surely ask for un UBMD because of the age of her sibling. Thank you for your ansqwer
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10 years 8 months ago #532 by Giuseppe Saglio
Replied by Giuseppe Saglio on topic Re: MDS 10 years after CCR three years after MMR >4
Thank you Alicia, but without SCT any response, if eventually achieved, will be transient. I think that it is a matter to be discussed and decided with the patient and her family. Yours, Beppe
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