I have a CML patient on nilotinib who is having arthralgias and raynauds-type symptoms. She would be keen to consider reducing her dose but I would be grateful for your advice about this.
She is 49, diagnosed 2010 presenting with white cell count 370. Hasford score 1007, Sokal 1.12.
Initial treatment on TIDEL II with hydroxyurea and imatinib 600mg daily, switched to nilotinib May 2011 due to residual BCR-ABL +ve 1.5%, August 2013 not achieved MMR, mutation analysis confirmed acquired L445P mutation.
MMR November 2013.
Continues on nilotinib 400mg BD currently.
Current BCR-ABL is 0.050 %IS and this has not moved for quite some time.
I have 2 questions/concerns – although she is currently asymptomatic, I am worried about the CVS risk with ongoing nilotinib at the higher dose and should I be concerned that her BCR is not moving at all?