Age 41 years, Chronic Myeloid Leukemia
Contributed By: Dr. Imtenan Sharif
Mr. Zaheer, 41 years of age, presented with short history of easy fatigability and weight loss in Dec 2014 at another hospital. Physical examination revealed a palpable spleen tip. Blood picture and bone marrow exam were consistent with Chronic Myeloid Leukemia in accelerated phase. PCR for bcr-abl1 was positive. The patient was put on nilotinib in Jan 2015 which was stopped due to severe pancytopenia in April 2015. The patient was then referred to AFBMTC in May 2015.
Bone marrow examination done at our center showed iatrogenic hypoplasia with focal collections of blasts and grade ll fibrosis. Cytogenetics were positive for Philadelphia chromosome in all metaphases of 46XY. On recovery of blood counts, the patient was given a trial of imatinib but once again the drug had to be stopped due to low platelets. On recovery of blood counts, the patient was given a trial of imatinib but once again the drug had to be stopped due to low platelets. 2016. Source of stem cell was bone marrow. Total nucleated cell dose was 4.28 x108/kg. GVHD prophylaxis was with ciclosporin and short methotrexate. Neutrophil engraftment was on 13th post-transplant day.
Mr. Zaheer was troubled by grade III mucositis but otherwise there was no major complication. He improved gradually and was discharged. Subsequently, mild chronic GvHD involving skin, eyes and liver developed due to which Immunosuppression was continued till 6 months after which tapering was started. Test for donor chimerism showed complete donor chimerism.
Mr. Zaheer is now on nilotinib (150mg twice daily) which he is planned to take for 2 years posttransplant. His latest FISH for BCR ABL is negative. There is no GvHD, he enjoys good quality of life with his family and has rejoined full time job.