Dasatinib Monotherapy to Maintain Complete Remission before Allogeneic Bone Marrow Transplantation under Monitoring of the Blastic Chronic Myelogenous Leukemia Biphenotypic Cells and Bcr-Abl Transcripts

Abstract

A 49-year-old male with blastic phase chronic myelogenous leukemia (CML-BP) with CD13/CD19 double-positive markers was treated with a combination of tyrosine kinase inhibitors and chemotherapy, followed by allogeneic bone marrow transplantation (allo-BMT). The biphenotypic cells and bcr-abl transcripts were monitored during the treatment course, and the efficacy of dasatinib for the treatment of the allo-BMT eligible CML-BP patient was evaluated. Following a single course of hyper-CVAD/MA with imatinib mesylate, the biphenotypic cells and bcr-abl mRNA decreased gradually, and hematological complete remission (CR) was achieved. Thereafter, dasatinib maintained the CR without any adverse events for four months. The allo-BMT was conducted successfully. Although minimal residual disease was apparently observed at the time of allo-BMT, bcr-abl mRNA became undetectable by nested realtime polymerase chain reaction (PCR) one month after the alloBMT. Thus, dasatinib monotherapy is feasible for maintaining the remission of CML-BP for at least a short duration before allo-BMT