Imatinib mesylate (Gleevec) is a bcr-abl tyrosine kinase inhibitor and the primary treatment agent for patients with CML. By binding to bcr-abl protein tyrosine kinase and inhibiting the bcr/abl pathway, imatinib reduces the proliferation of bcr/abl-positive CML cells. imatinib is currently approved as a standard initial treatment for patients with chronic-phase CML. If the rate of complete cytogenetic remission has approved but thrombocytosis still present. The next step increase dose or add hydroxyurea or shift to second line
in patients with CML we have to take care that thrombocytosis not responding to therapy is sign of accelaration and patient should be treated as such
It would be better to rule out causes of secondary thrombocytosis such as GI bleeding. If those are negative, I would be worried about progression, and it would be better to repeat bone marrow aspiration and biopsy, and send bone marrow aspirate for mutation analysis.
Thank you Dr Mojtaba , That what we are doing for evaluation and excluding the progression to accelation phase.
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