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× 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.

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Time for a difficult decision

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10 years 5 months ago #850 by nhijiya
Dear David,

We had a case that was almost identical to your case. This is a teenage boy with serious compliance and social issues. The treating physician tried imatinib, dasatinib and nilotinib, but he was not compliant, then tried omacetaxine. He is stable on it now. The difference in his case is that he does not have a good donor and refused transplant.

For your patient, I would be inclining to transplant having the fact that she has a good donor and better outcome with transplant in children/adolescents in general. She has another 60-70 years of life expectancy. Compliance with post-transplant medication may be an issue, but it is not indefinite like TKI.

Nobuko

Nobuko Hijiya, M.D.
Pediatric Hematology/Oncology
Lurie Children's Hospital
Northwestern University
Moderators: Nicolaarlene