Aplasia in Chronic Phase CML Post-TKI Therapy: A Management Dilemma

Figure 2

Hematologic parameters in patients with CML treated with imatinib, dasatinib, and subsequent nilotinib. White blood cells (WBC), hemoglobin (Hb), and platelets (PLTs) are depicted over a 45-month period until patient’s death. The graph is divided into five frames: (1) initiation of imatinib and lack of adequate response due to noncompliance. Subsequent dose adjustments and continuation of treatment until month 18. (2) Initiation of dasatinib following discontinuation of imatinib due to lack of proper response. (3) Treatment was switched to nilotinib on month 23 due to persistent cytopenias and intolerable side effects. Bone marrow biopsy on month 25 revealed trilineage hypoplasia. (5) Discontinuation of nilotinib on month 34 due to persistent pancytopenia and marrow fibrosis attributed to TKI. (6) Decision to resume nilotinib with plan for urgent BMT frustrated by complications leading to death of the patient on month 45.