Κυριακή 31 Ιουλίου 2011

CML TREATMENT

Key Issues

  • All newly diagnosed chronic-phase chronic myeloid leukemia patients patients should be investigated thoroughly including history, physical examination, complete blood count examination, bone marrow examination and cytogenetic analysis.
  • Although two Phase III studies demonstrated the superiority of dasatinib and nilotinib over imatinib, the follow-up is short. Hence, for the majority of patients, imatinib 400 mg/day remains the optimal first-line therapy. However, this is a debatable issue and long-term follow-up of these studies may clarify the issue.
  • Patients treated with tyrosine kinase inhibitor therapy should be monitored closely with complete blood count examination, and bone marrow cytogenetic analysis every 6 months until complete cytogenetic response is achieved. Once complete cytogenetic response is achieved, these patients can be monitored by BCR–ABL1 transcript levels.
  • In imatinib-failure patients, compliance should be checked and changing the imatinib drug level can be helpful.
  • Patients with confirmed imatinib failure should be further investigated with BCR–ABL1kinase domain mutation analysis, bone marrow examination and cytogenetic analysis.
  • For imatinib-resistant patients harboring F317L/V/C and V399L mutations, nilotinib is a better option.
  • For imatinib-resistant patients harboring Y253F, E255K or F359C mutations, dasatinib is a better option.
  • For patients with T315I mutations, treatment options are very limited and allogeneic stem-cell transplantation is the only curative therapy for these patients.
  • Patients on second-line therapy who fail to achieve minor cytogenetic response or BCR–ABL1 transcripts of <10% by 3 months; or major cytogenetic response by 12 months of therapy have poor prognosis and hence alternative therapeutic options should be explored for these patients.

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