34 year old MALE. At 17 in 1997 he was diagnosed with CML in CPHASE. No donor among the sibling. No possibility to access a ITK. Treated with high dose the IF + ARAC with no great response - Progression to AP. In 2001 enter at the end of the compassionate arm of Novartis for few months. No response to Gleevec. Finally in 2003 we began with our UBMT PROGRAMME and he was the first one to access a UBMT in our country. He did very well but molecular relapse after one year. Unrelated DLI partial response. He is under Gleevec 600 mg since 2006 with RMM sustained. At this moment he desire a child. So I told him to stop glivec till grossese is confirmed at that moment to restart Gleveec. QRTPCR each three months. It is necessary for him to restart with TKI after 10 years of URBMT He was our first UBMT. Should I perform a cytogenetic before restarting with ITK. For how long should he must continue on ITK if RMC. Is he cured now'?

Firstly I don’t believe there is any need to cease imatinib in male patients wishing to conceive. I don’t instruct my patients to stop for this purpose – there is no evidence that imatinib present in the male increases the risks of fetal malformations or miscarriage to my knowledge. Since he probably received ablative chemoradiotherapy for his allograft he may well be infertile so a sperm check and some expert fertility advice may be appropriate now.

The second interesting question is whether it would be safe for him to stop TKI therapy now - 10 years after an unrelated transplant. Given the fact that his disease transformed to AP (was this well documented?) prior to his allograft and that he relapsed 1 year post allograft I would not be in any hurry to cease his imatinib. There are many reports of successful cessation of imatinib in patients who relapsed post allograft and then achieved a complete molecular response to imatinib but this case is more high risk than most. The most conservative approach would be to continue imatinib and to monitor his response with an RQ-PCR test from the blood every 3-6 months. If he insists on stopping then you would need to monitor him very frequently by PCR (monthly if possible) because molecular relapse may be quite rapid and lead to a steep rise in BCR-ABL. All of this advice assumes that you have access to good quality sensitive and standardised PCR testing.

Cytogenetic monitoring would only be relevant if his BCR-ABL level was >1% (IS).

I agree with Tim, but have you performed a sperm analysis? Unfortunately after conditioning regimen for UBMT many patients are no more fertile and alternative options to natural conception have to be considered.