Skip to main content
. 2017 Feb 18;8(14):23061–23072. doi: 10.18632/oncotarget.15481

Figure 1. Overview of clinical course and response to TKI rotation therapy.

Figure 1

(A) Response to treatment with nilotinib and ponatinib, and influence of TKI therapy on blood counts and BCR-ABL1 mRNA levels: The patient was treated with nilotinib after resistance against dasatinib had been documented. During nilotinib, BCR-ABL1 decreased but did not disappear. After several months, BCR-ABL1 increased again and cytopenia developed. Finally, the patient developed blast crisis and treatment with ponatinib was initiated. In response to ponatinib, BCR-ABL1 mRNA levels decreased, but the patient developed severe thrombocytopenia. (B) Response to treatment with ponatinib/bosutinib-rotation and hydroxyurea (HU): Because of thrombocytopenia, the patient was switched to bosutinib (after a short phase of imatinib-bridging). During bosutinib, platelet counts recovered slowly, but BCR-ABL1 increased again. Therefore, we switched back to ponatinib, and finally decided to apply ponatinib and bosutinib in continuous rotation-cycles together with low-dose HU. Under this therapy, blood counts normalized, the patient entered a stable continuous complete response, and has a normal quality of life without major side effects.