International Journal of Hematology

, Volume 93, Issue 2, pp 243–246

Successful treatment with nilotinib after imatinib failure in a CML patient with a four-way Ph chromosome translocation and point mutations in BCR/ABL gene

  • Masaya Okada
  • Atsushi Satake
  • Katsuji Kaida
  • Kyoko Taniguchi
  • Satoshi Yoshihara
  • Kazuhiro Ikegame
  • Hiroya Tamaki
  • Toshihiro Soma
  • Yoshihiro Fujimori
  • Hiroyasu Ogawa
Case Report

DOI: 10.1007/s12185-011-0769-z

Cite this article as:
Okada, M., Satake, A., Kaida, K. et al. Int J Hematol (2011) 93: 243. doi:10.1007/s12185-011-0769-z

Abstract

Chronic myelogenous leukemia (CML) is characterized by Philadelphia (Ph) chromosome with a chimeric gene BCR–ABL created by reciprocal t(9:22) (q34;q11) translocation. Variant Ph chromosome translocations involving chromosomes other than 9 and 22 are found in 5–10% of CML cases. We here report a CML patient who carries a four-way Ph chromosome translocation, t(9;22;15;19) (q34;q11;q15;q13). The patient was diagnosed in 1997 and initially treated with hydroxyurea. In 2002, treatment with imatinib, a selective BCR–ABL tyrosine kinase inhibitor (TKI), was started but Ph-positive chromosomes remained at the levels of 42–65%, indicating imatinib failure. In 2006, the point mutations of F359I and L387M were detected in BCR/ABL gene, which may be related to imatinib failure. Treatment with nilotinib, a TKI with high target specificity, was then started which resulted in durable major molecular response. Administration of nilotinib offered an effective treatment in a CML patient with variant Ph chromosome translocations and BCR–ABL point mutations after imatinib failure.

Keywords

Chronic myelogenous leukemiaVariant Philadelphia chromosomePoint mutationNilotinib

Copyright information

© The Japanese Society of Hematology 2011

Authors and Affiliations

  • Masaya Okada
    • 1
  • Atsushi Satake
    • 1
  • Katsuji Kaida
    • 1
  • Kyoko Taniguchi
    • 1
  • Satoshi Yoshihara
    • 1
  • Kazuhiro Ikegame
    • 1
  • Hiroya Tamaki
    • 1
    • 2
  • Toshihiro Soma
    • 1
  • Yoshihiro Fujimori
    • 2
  • Hiroyasu Ogawa
    • 1
    • 2
  1. 1.Division of Hematology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
  2. 2.Laboratory of Cell Transplantation, Institute for Advanced Medical SciencesHyogo College of MedicineNishinomiyaJapan