During IFN-alpha monotherapy, the T315I mutation levels were reduced from 100% to 4% in patient no 5 (Fig 1), but two other mutations appeared (F317L and E255V). This 85-year old patient died of lung tuberculosis with an overall survival of 44 months. We observed a basic division of T-lymphocyte fractions during treatment management. The best IFN-alpha therapy outcome was described among others in patients younger than 60 years. The enhancing effect of IFN-alpha on the immune response was probably deficient in this elderly patient. In addition, the higher incidence of mutations may be related to advanced age.
The concept of TKI cessation and IFN-alpha introduction did not contribute to the T315I reduction or to response improvement in patient no 6 (Fig 1). Recently, it was possible to switch therapy to ponatinib with a reduction of total BCR-ABL1 transcripts to MMR levels, which was associated with a simultaneous reduction of T315I.