Table 1 Clinical Course of Patient
Dates (Time from transplant) | March 2009 At Diagnosis | February 2010 (Day 100) | September 2010 (10 Months) | October 2010 (11 Months) | December 2010 -January 2011 (14 Months) | February 2011 (15 Months) | April 2011 (17 Months) | June 2011- October 2011 (19–24 Months) |
|---|---|---|---|---|---|---|---|---|
Bone Marrow Biopsy Morphology | Hypercellular 90% with 56% B-Lymphoblasts | No evidence of disease | Not done | No evidence of disease | Recurrent disease comprising 71% of total cells | Residual disease 4.4% CD34+ TDT + Blasts | No evidence of residual/recurrent disease | No evidence of residual/ recurrent disease |
Donor Chimerism BM/PB | N/A Female recipient | 100% male donor by chromosomes and STR (BM) | Not done | 100% male donor | 12% male donor | 100% male donor | Not done | 100% male donor |
FISH/ PCR BCR/ABL Blood or Bone Marrow | Philadelphia Chromosome Positive | Negative for BCR/ABL translocation by RT-PCR (BM) | Negative for BCR/ABL translocation (PB) | Positive minor breakpoint .014% | FISH positive BCR/ABL; RT PCR positive for the minor breakpoint region 39.22% | 4.4 percent by FISH analysis | Negative for BCR/ABL translocation by RT-PCR | Negative for BCR/ABL translocation |
TKI treatment | N/A | None | Gleevec 100 mg* | Gleevec 100 mg* | Nilotinib (400 mg po bid started) | Nilotinib (400 mg po bid) | Nilotinib 800 mg (400 mg po bid) | Nilotinib (400 mg po bid) |
GVHD | N/A | skin and gut | skin | skin | skin | skin, eyes, mouth, and gut | skin, eyes, mouth, and gut | skin, eyes, mouth, and gut |
ECP | N/A | None | None | None | None | None | None | ECP ** |
IST | N/A | Cyclosporine and Prednisone | Cyclosporine and Prednisone | Weaned | Discontinued | Cyclosporine: 125 mg p.o.b.i.d. | Cyclosporine: 150 mg p.o.b.i.d. | CellCept: 1000 mg p.o.b.i.d. |
Prednisone: 25 mg daily | Prednisone: 10 mg |