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imatinib resistance.what is the prognosis from now on

hi, all.after three years taking imatinib now i have become imatinib resistant.changed to nilotinib.i wish to know approximate prognosis from now on.thank you.

Hard to say for sure, but you're probably not going to enjoy having to take it every twelve hours.  Your side effects will most likely be different than they were on imatinib.

On the bright side, your CML will probably be more responsive to nilotinib!  Maybe you'll be able to try going treatment free after a couple of years or so.

Your doctor is a moron and I would look to change doctors.  Nilotinib works nearly identically to Imatinib, you should have been switched to Dasatinib.  

 

You also have Bosulif if all of those fail and ABL001 (trial) as a last resort, but by that time, CML will likely be cured.

It is true that nilotinib works in a similar fashion to imatinib, but it is much stronger and is effective against many of the kinase domain mutations that cause resistance to imatinib. Nilotinib has more serious potential side effects, mostly cardiovascular, as does dasatinib (mostly pleural cavity and PAH), so the choice of 2nd line therapy often has as much to do with your individual profile as it does with how the specific TKI "works."

Your doctor is not necessarily a moron - just make sure you quiz him/her thoroughly on why nilotinib was chosen vs. dasatinib vs. bosutinib.  Not all oncologists are CML specialists.  Your prognosis is still excellent. Good luck.

Hi, is your resistance due to an imatinib-resistant mutation? If so do you know which mutation you have?

Even if your clinician has not identified a mutation but feels your PCR results are not optimal (0.1%/MR3 or lower) it makes sense to change your treatment to a 2nd gen TKI like nilotinib, dasatinib or bosutinib. One or other of these TKIs may well be the answer, so your prognosis remains good. 

If your clinician has identified a resistant mutation, it would be good to ask which one as each TKI differs in efficacy depending on the identified resistant mutation.

For instance, I developed the Y253H mutation which is best treated with bosutinib- although that was not available in 2003 so I had an SCT- which was successful!

For those with T315i mutation, currently, ponatinib is the TKI that is effective.

Sandy

Thank you ma'am for your reply.i was expecting your reply.my pcr was .00017 i.e log 4.5 but my fish report was 40 % positive.so we again went for fish test and the result was 20% positive.my doctor didnt suggest for mutation test simply changed me from imatinib from nilotinib.all these time my hematologic reports were normal.no increase in white cells.so confusing.lets assume i have become imatinib resistant with some mutation.do i have good prognosis.please provide examples of your friends who become imatinib resistant and survives more than 10 years.waiting for your reply.

Sathish, it's very unusual to have a FISH test with a result that high as your PCR result is nearly undetectable.  I haven't had a FISH test since my first year of treatment (2012-2013). How many FISH tests have you had since your CML diagnosis?

Hi

I was on nilotinib from the start of my diagnosis. My levels went to 0.019 then started rising. My hematologist checked for mutations and i had one which was both imatinib and nilotinib resistant but sensitive to dasatinib so i have been on that almost a year now, awaiting my new result. 3 months ago was 0.022

My hematologist said resistance is not checked initially and there maybe these resistant cells from the getgo but are minimal in number compared to others and when others decrease then these resistant ones increase.

So if you are imatinib resistant vital to check for mutation and sensitivity testing so that the right medication can be given for you rather than just another TKI
So if sensitive to nilotinib or dasatinib then your prognosis should be good

If not then there are other options. Hope this helps you. Im a doctor(gp) and a CML patient. Im not a hematologist so kindly discuss what ive advised with your hematologist who knows better....