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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify the presenting signs and symptoms of chronic myelogenous leukemia (CML).

  • Identify important prognostic indicators for CML.

  • Discuss available treatment options for newly diagnosed CML and refractory or relapsed CML and recommend an appropriate therapy.

  • Choose appropriate parameters to monitor efficacy and potential adverse effects of treatment for CML.

  • Educate patients on dosing and administration, the importance of adherence, and the most common side effects of the selected therapy for CML.

  • Discuss potential mechanisms of resistance to first-line therapy for CML and formulate a treatment strategy for these patients.

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PATIENT PRESENTATION

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Chief Complaint

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“I’m here for my routine visit for my back pain, but I have been feeling pretty tired lately and have this dull pain in my abdomen.”

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HPI

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Carl Boyd is a 55-year-old man with a history of chronic back pain secondary to injury 5 years ago; he presents for his annual appointment and physical. Today he complains of left-sided abdominal discomfort and fullness that has resulted in some decreased appetite and increasing fatigue and inactivity over the past 3 months. When questioned, he reports experiencing intermittent drenching night sweats for the past 2 months that seem to be more frequent now.

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PMH

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  • Chronic back pain

  • Childhood asthma, last symptoms at age 21

  • Appendectomy 16 years ago

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FH

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Father died at age 66 due to MI. Mother is living, 71 years old with osteoporosis, depression, and GERD. He has one sister, age 52, living in Maine with no known medical issues. Paternal grandfather had prostate cancer but passed away from unrelated causes. Patient has no natural children.

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SH

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Married and has one stepson, age 19, who attends college overseas. He works as a nurse in a local long-term care facility, and his wife is a tax accountant. He has no smoking history but drinks alcohol on social occasions. He denies any illicit drug use.

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Meds

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  • One-A-Day multivitamin PO once daily

  • Cyclobenzaprine 10 mg PO BID as needed

  • Ibuprofen 800 mg PO TID as needed

  • Oxycodone 10mg every 6 H as needed

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All

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NKA

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ROS

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Positive for increased weakness and tiredness, frequent night sweats, mild shortness of breath on exertion, general musculoskeletal pain, and LUQ pain. Denies bleeding, headaches, vision changes, nausea, vomiting, chest pain, rashes, numbness or tingling in extremities, or urinary symptoms.

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Physical Examination

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Gen
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Caucasian man who appears his stated age and is in no obvious distress

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VS
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BP 122/60 mm Hg, P 63 bpm, ...

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