Treatment with nilotinib after cytogenetic relapse at 12 months in a patient in chronic phase with sub-optimal response to imatinib

We report a case of patient with chronic myeloid leukemia who started imatinib at standard dose and obtained a sub-optimal response at 6 months. Considering the patient as a possible “late responder”, we decided not to change the imatinib dose, but, at 12 months, we did not achieve a complete cytogenetic response. At that time, we decided to switch to a second-generation tyrosine kinase inhibitor (TKI), nilotinib 800 mg/day, obtaining soon a major molecular response. Recently, the retrospective application of European LeukemiaNet guidelines in large cohorts of patients suggested that patients whose response to imatinib is sub-optimal at 6 months showed significantly worse survival. Therefore we can hypothesise that this kind of patients could be eligible for an early switch to second-generation TKI.