Introduction
Chronic myeloid leukemia is a myeloproliferative disorder which is characterized by increase amplification of the granulocytic cell line with fairly normal differentiation. The main hallmark of CML is deregulated tyrosine kinase activity catalyzed by BCR/ABL1 fusion protein which results on Philadelphia chromosome(1).
Treatment of CML has been revolutionized with the presence of BCR-ABL1 targeting TKI,which has improved the overall survival and quality of patient’s life. Imatinib was the first of these to be used in the treatment of CML(2)..Several other tyrosine kinase inhibitors (TKIs) have been developed and tested in patients with CML, most notably dasatinib, nilotinib, bosutinib, and ponatinib. Despite the excellent outcome, half of the patients will eventually fail due to intolerance or resistance to first line treatment, with many of them requiring a third or even further lines of therapy(3, 4).
We report a case of CML who initially didn’t tolerate dasatinib and Nilotinib but showed excellent response to Bosutinib and achieved major molecular response in just 4 months of therapy.