hello, I would be quite conservative in this lady with congenital heart disease after double life saving surgery and AV block. I would consider slower move towards CML control, therefore even in case of some manifestations of her heart disease (peripheral edema, but she is on furosemide) I would start with imatinib standard dose especially EUTOS is low. It would help to have ELTS survival estimate as one of possible leads in choice, but dasatinib is not suitable due to open heart surgery and possible effusions, and similarly nilotinib with metabolic effects are not my choice in the moment. Both, dasa and nilo may have QT prolongation and in such a case many unusual things could happen by Marphy. It would be a problem if she needs second line treatment? Moreover I have checked with such treatment there would no significant interactions with TKI's at all.
ORIGINAL CASE:
This is a 37-y-o patient with recently diagnosed CML EUTOS score low. She has a history of congental cyanotic cardiopathy that has been surgically corrected on 2 occasions. She has a complete AV block and is on furosemide 20mg/d, ramipril 5md/d and carbamazepine 400mg/d (this is due na epitlogenic focus after a TIA), and leads a normal life.
what is the best TKI to start treatment with? Bosutinib?