U.A. YAKUBOVA^1, 2, N.V. BUCHNEVA¹, D.M. MIRMANOVA¹

 ¹Orenburg State Medical University, Orenburg

²Orenburg Regional Clinical Hospital named after V.I. Voynov, Orenburg

Contact details:

Yakubova U.A. — PhD (Medicine), Assistant Lecturer of the Department of Faculty Therapy and Endocrinology, hematologist

Address: 6 Sovetskaya St., 460014 Orenburg, Russian Federation, tel.: +7-919-864-92-69, e-mail: yakubova.uliana@yandex.ru

Currently, the leading treatment for chronic myeloid leukemia (CML) is targeted therapy, which directly targets the underlying cause of the disease — the tyrosine kinase activity of the BCR::ABL1 chimeric gene product. This said, virtually all tyrosine kinase inhibitors (TKIs) are multitargeted, which determines not only their effectiveness but also their safety profile. The article presents a clinical case of a patient with a 24-year history of CML. This case demonstrates the complexity of choosing the optimal therapeutic strategy in a patient with imatinib refractoriness, intolerance to dasatinib (recurrent pleural effusion) and bosutinib (hepatotoxicity), and contraindications to nilotinib due to severe cardiovascular disease (myocardial infarction, coronary artery bypass grafting, hypertension, obesity). An attempt to discontinue TKIs resulted in a molecular relapse, while high comorbidity and the absence of siblings precluded the allohematopoietic stem cell transplantation. A distinctive feature of this case is the consistent and clinically justified approach to TKI selection at all stages, following the principles of personalized medicine and international approaches.

Key words: chronic myeloid leukemia, tyrosine kinase inhibitors, imatinib, nilotinib, dasatinib, bosutinib, asciminib

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