title: CML clonal evolution with resistance to single agent imatinib therapy.
abstract: We describe a 58-year-old male diagnosed with chronic myeloid leukaemia (CML) who failed to have a cytogenetic response to interferon-alpha and hydroxyurea. On subsequent therapy with imatinib mesylate he failed to have any cytogenetic response but also developed a complex clonal evolution with an additional Philadelphia (Ph) chromosome and trisomy 8 respectively in two Ph-positive subclones. The addition of cytosine arabinoside to imatinib resulted in reversion to single Ph-chromosome positivity with the disappearance of the previous additional clonal abnormalities. The case demonstrates the efficacy of combined treatment with imatinib and cytarabine in the management of CML resistant to single agent imatinib.
authors.affiliation: Department of Haematology, Beaumont Hospital, Dublin, Ireland. ronanswords@yahoo.co.uk
authors.forename: R
authors.initials: R
authors.lastname: Swords
authors.forename: J
authors.initials: J
authors.lastname: Quinn
authors.forename: M
authors.initials: M
authors.lastname: Fay
authors.forename: R
authors.initials: R
authors.lastname: O'Donnell
authors.forename: J
authors.initials: J
authors.lastname: Goldman
authors.forename: P T
authors.initials: PT
authors.lastname: Murphy
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001549:Benzamides; D002471:Cell Transformation, Neoplastic / Q000139:chemically induced* / Q000235:genetics; D002999:Clone Cells / Q000473:pathology; D003561:Cytarabine / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D000068877:Imatinib Mesylate; D016898:Interferon-alpha / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010677:Philadelphia Chromosome; D010879:Piperazines / Q000009:adverse effects* / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D012074:Remission Induction / Q000379:methods; D017211:Treatment Failure; D014314:Trisomy
chemical_list: D001549:Benzamides; D016898:Interferon-alpha; D010879:Piperazines; D011743:Pyrimidines; D003561:Cytarabine; D000068877:Imatinib Mesylate; D006918:Hydroxyurea