Case Report: Modified transplantation for a unilobed patient with chronic myeloid leukemia

Although the use of tyrosine kinase inhibitors (TKI) for BCR::ABL in patients with chronic myeloid leukemia (CML) has significantly improved long -term life expectancy, the prognosis for patients with TKI resistance or for those who present with advanced disease is still dismal. As reported in numerous studies, the incidence of CML is higher in males than in females; however, the significant difference has not been observed with respect to age. CML consists of three clinical phases. The first stage is the chronic phase, and the second is accelerated phase, which usually lasts about 3 years; approximately 10% of cases in these two phases progress to the third phase (blastic phase). Allogeneic hematopoietic stem-cell transplantation remains the only curative option for patients with advanced CML. Here, we report a rare case of a 55-year-old female patient with CML who achieved successful outcomes following a lobectomy necessitated by a mucor infection. She experienced an early relapse in the central nervous system (CNS), and prompting a switch in treatment to a different TKI, intrathecal chemotherapy, craniospinal irradiation, and a combination regimen, including azacitidine, venetoclax and cytarabine. The patient presented with early-phase CNS-involved CML during TKI treatment, and subsequently received a transplant from a matched sibling donor using our modified conditioning regimen. This approach was appropriate for the patient. In this case of refractory and relapsed CML complicated by extramedullary involvement, particularly following pathological confirmation after pulmonary lobectomy, we adopted a modified conditioning regimen, which ultimately saved the patient’s life. This strategy serves as a reference for therapeutic approaches for future cases with extremely poor prognosis.