TABLE 1.
Hematological and chemical laboratory data after initiation of imatinib and second kidney transplantation
| Months after starting imatinib | 0 | 3 | 6 | 9 | 12 | 15 | 18 | 21 | 24 | 27 | 30 | 33 | 36 | 42 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Months after transplantation | 0.5 | 3 | 6 | 9 | 12 | 15 | 18 | 24 | ||||||
| Hematologic response | ||||||||||||||
| White blood cell count (4.0‐9.0 g/L) | 19.3 | 12.3 | 11.3 | 9.4 | 10.3 | 11.6 | 19.0 | 9.4 | 12.4 | 11.0 | 14.2 | 10.8 | 10.5 | 12.8 |
| Neutrophils (50%‐70%) | 78.9 | 79.0 | 71.4 | 73.4 | 75.0 | 74.4 | 85.1 | 74.0 | 81.6 | 77.0 | 84.0 | 77.6 | 79.2 | 82.9 |
| Hemoglobin (13.5‐17.5 g/dL) | 9.3 | 12.7 | 14.7 | 12.1 | 13.8 | 9.6 | 9.2 | 11.2 | 12.3 | 12.9 | 13.9 | 13.1 | 13.7 | 13.6 |
| Platelets (130‐400 g/L) | 699 | 540 | 411 | 384 | 312 | 430 | 461 | 388 | 366 | 310 | 357 | 364 | 331 | 334 |
| Cytogenetic response | ||||||||||||||
| No. of Ph+ metaphases in bone marrow | 8/20 | 0/20 | ||||||||||||
| Molecular response | MR3 | MR4 | MR4 | MR4 | MR4 | MR5 | MR4 | MR4 | MR4.5 | MR4.5 | MR4.5 | MR4.5 | ||
| BCR‐ABL IS (%) in peripheral blood | 25 | 0.4 | 0.02 | 0.01 | 0.0066 | 0.0049 | 0.0056 | 0.00089 | 0.0061 | 0.0064 | 0.003 | 0.003 | 0.003 | 0.003 |
| Renal allograft function | ||||||||||||||
| Serum creatinine (mg/dL) | 1.87 | 1.40 | 1.26 | 1.30 | 1.22 | 1.23 | 1.04 | 1.09 | ||||||
| eGFR (mL/min per 1.73 m2) | 40 | 56 | 63 | 61 | 66 | 65 | 79 | 75 | ||||||
| Immunosuppression | ||||||||||||||
| Tacrolimus trough level (ng/mL) | 12.8 | 10.0 | 5.9 | 6.2 | 7.5 | 5.6 | 4.1 | 4.6 | ||||||
| Tacrolimus dose (mg/d) | 6 | 1.5 | 1 | 1 | 1 | 2 | 1 | 1 | ||||||
| Mycophenolate mofetil (mg/d) | 2000 | 2000 | 2000 | 2000 | 2000 | 1000 | 1000 | 1000 | ||||||
| Prednisolone (mg/d) | 20 | 5 | 2.5 | 2.5 | 5 | 5 | 5 | 5 | ||||||
Treatment monitoring in patients with chronic myeloid leukemia includes assessment of (1) hematologic, (2) cytogenetic, and (3) molecular response. (1) Complete hematologic response as indicated by improved complete blood cell and differential cell counts occurred 3 mo after treatment start. (2) By cytogenetic testing the number of bone marrow cells in metaphase carrying the Philadelphia chromosome (Ph+) is assessed. The absence of the Philadelphia chromosome after 3 mo indicates complete cytogenetic response. (3) The most sensitive method of monitoring residual disease is measuring the level of breakpoint cluster region‐abelson (BCR‐ABL) transcript in peripheral blood by quantitative reverse‐transcriptase polymerase chain reaction as an indicator of the number of circulating leukemic cells. Molecular response is assessed according to the International Scale (IS) as the ratio of BCR‐ABL transcripts to the control gene ABL expressed as BCR‐ABL IS % on a log‐scale. A BCR‐ABL transcript level ≤0.1% reflects a ≥3 log‐reduction of BCR‐ABL mRNA transcripts and corresponds to a molecular response MR3 (also referred to as major molecular response). Accordingly, a BCR‐ABL transcript level ≤0.01%, ≤0.0032%, and ≤0.001% corresponds to a MR4, MR4.5, and MR5, respectively (also referred to as deep molecular response). Reference ranges are indicated in parentheses. eGFR denotes estimated glomerular filtration rate calculated according to the CKD‐EPI (Chronic Kidney Disease Epidemiology Collaboration) equation.