IM breaks and blast crisis - Tracey

[Guest guest]

> Posted by: " Tracey " traceyincanada@...

>

> Hi Everyone,

>

> I've been debating whether or not to post this because I don't want

> to scare anyone unnecessarily....

> ....I have an abstract

> ( http://www3.interscience.wiley.com/cgi-

> bin/abstract/109084458/ABSTRACT?CRETRY=1 & SRETRY=0 ) that shows how

> two patients went into blast crisis after taking a 2 week break from

> Gleevec which demonstrates the risk pretty strongly I would say but

> again, I'm not posting this to scare anyone, just to inform you that

> there are options and there are risks with everything we do.

>

> Take care,

> Tracey

> dx Jan 2002

Hi Tracey,

This case report is fascinating and deserves close examination. I plan to

track down the authors if possible and ask them more about the two cases,

including what phase these patients were in at the time of diagnosis, and

what criteria they used to identify blast crisis. Nearly as surprising as

these patients' rapid response to IM withdrawal is the statement that " the

same doses of imatinib mesylate was still effective and remission was

sustained with imatinib mesylate alone again. " This is wholly inconsistent

with the experience of most patients in blast crisis, where IM-induced

remission is not durable. I have to admit, it makes me question the

diagnosis of blast crisis in this instance. I'll let you know what I find

out.

How are you doing, btw? We haven't been in touch for a long time.

Best,

R

Dx'd 10/00

PS - I append the abstract below

_______________

American Journal of Hematology

Volume 76, Issue 3 , Pages 275 - 278

Published Online: 22 Jun 2004

Case Report

Imatinib mesylate-sensitive blast crisis immediately after discontinuation

of imatinib mesylate therapy in chronic myelogenous leukemia: Report of two

cases

Takehiro Higashi 1, Junichi Tsukada 1 *, Chiaki Kato 2, Atsushi Iwashige 1,

Takamitsu Mizobe 1, Shinichiro Machida 1, Hiroaki Morimoto 1, Ryosuke Ogawa

1, Yoko Toda 1, Yoshiya Tanaka 1

1First Department Internal Medicine, University of Occupational and

Environmental Health, School of Medicine, Kitakyushu, Japan

2First Department Internal Medicine, Nagoya University School of Medicine,

Nagoya, Japan

email: Junichi Tsukada (jtsukada@...)

*Correspondence to Junichi Tsukada, First Department of Internal Medicine,

School of Medicine, University of Occupational and Environmental Health, 1-1

Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan

Abstract

Although imatinib mesylate has shown encouraging activity in chronic

myelogenous leukemia (CML), disease progression during therapy has been

observed, manifested by clonal expansion of imatinib mesylate-resistant

leukemia cells. On the other hand, myelosuppression related to treatment of

imatinib mesylate is often managed with temporary interruption of treatment

or dose reduction. We here report two CML patients who had imatinib

mesylate-sensitive blast crisis (BC) immediately after discontinuation of

imatinib mesylate therapy. The patients discontinued therapy because of

neutropenia. Although there was no evidence of blastic phase during therapy,

BC occurred 2 weeks after the withdrawal of treatment in both cases.

Interestingly, additional chromosomal abnormalities were detected following

the withdrawal of imatinib mesylate and disappeared by re-introduction of

this agent. The same doses of imatinib mesylate was still effective and

remission was sustained with imatinib mesylate alone again. Our report

suggests the possibility that withdrawal of imatinib mesylate may lead to

proliferation of blast clones even in patients showing good responses to

imatinib mesylate without signs of disease progression. Am. J. Hematol.

76:275-278, 2004. © 2004 Wiley-Liss, Inc.