Chronic myelogenous leukemia (CML) is characterized by Philadelphia (Ph) 
chromosome with a chimeric gene BCR-ABL created by reciprocal t(9:22) (q34;q11) 
translocation. Variant Ph chromosome translocations involving chromosomes other 
than 9 and 22 are found in 5-10% of CML cases. We here report a CML patient who 
carries a four-way Ph chromosome translocation, t(9;22;15;19) (q34;q11;q15;q13). 
The patient was diagnosed in 1997 and initially treated with hydroxyurea. In 
2002, treatment with imatinib, a selective BCR-ABL tyrosine kinase inhibitor 
(TKI), was started but Ph-positive chromosomes remained at the levels of 42-65%, 
indicating imatinib failure. In 2006, the point mutations of F359I and L387M 
were detected in BCR/ABL gene, which may be related to imatinib failure. 
Treatment with nilotinib, a TKI with high target specificity, was then started 
which resulted in durable major molecular response. Administration of nilotinib 
offered an effective treatment in a CML patient with variant Ph chromosome 
translocations and BCR-ABL point mutations after imatinib failure.