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An approach to the management of chronic myeloid leukemia in British Columbia.

Forrest DL, Jiang X, Eaves CJ, Smith CL - Curr Oncol (2008)

Bottom Line: With the introduction of the tyrosine kinase inhibitor (tki) imatinib mesylate, the treatment outcomes for patients with cml have improved markedly, and hematopoietic stem-cell transplantation is no longer routinely offered as first-line therapy for most patients in chronic phase.However, resistance to tki therapy is increasingly being recognized, and alternative therapy is needed for this group of patients.In addition, the development of models predicting response to tki therapy is desired, so that appropriate treatment strategies can be used for individual patients.The present report serves to outline the approach to the treatment of cml in British Columbia and to highlight areas of ongoing research.

View Article: PubMed Central - PubMed

Affiliation: Leukemia/BMT Program of BC, Division of Hematology, General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, BC. dforrest@bccancer.bc.ca

ABSTRACT
Chronic myeloid leukemia (cml) is a myeloproliferative disorder whose therapy has changed dramatically since the late 1990s. With the introduction of the tyrosine kinase inhibitor (tki) imatinib mesylate, the treatment outcomes for patients with cml have improved markedly, and hematopoietic stem-cell transplantation is no longer routinely offered as first-line therapy for most patients in chronic phase.However, resistance to tki therapy is increasingly being recognized, and alternative therapy is needed for this group of patients. In addition, the development of models predicting response to tki therapy is desired, so that appropriate treatment strategies can be used for individual patients. The present report serves to outline the approach to the treatment of cml in British Columbia and to highlight areas of ongoing research.

No MeSH data available.


Related in: MedlinePlus

Treatment algorithm for chronic myeloid leukemia (cml) in blast phase (bp). vcr = vincristine; dnr = daunorubicin; Pred = prednisone; sp2 = second stable phase; hidac = high-dose cytarabine; sd = sibling donor; Allo = allogeneic; sct = stem-cell transplantation; Mud = matched unrelated donor; pb = peripheral blood; qpcr = quantitative polymerase chain reaction.
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f3-co15_2p090: Treatment algorithm for chronic myeloid leukemia (cml) in blast phase (bp). vcr = vincristine; dnr = daunorubicin; Pred = prednisone; sp2 = second stable phase; hidac = high-dose cytarabine; sd = sibling donor; Allo = allogeneic; sct = stem-cell transplantation; Mud = matched unrelated donor; pb = peripheral blood; qpcr = quantitative polymerase chain reaction.

Mentions: With the introduction of tkis (imatinib, dasatinib, nilotinib), much has changed in the standard approach to cml therapy. Before imatinib became available, most cml patients received treatment with interferon alpha, with or without cytarabine, or alternatively underwent allogeneic stem-cell transplantation if deemed eligible with a suitable donor. As compared with hydroxyurea or busulfan, interferon alpha has been shown to prolong survival; however, only a small proportion of patients (20%–30%) achieve a major cytogenetic response, and the survival benefit is largely limited to such responders 7, 8. Furthermore, interferon is associated with a number of dose-related toxicities, and most patients require dose reductions or discontinuation. For those reasons, interferon therapy has been largely replaced by the more effective and less toxic tkis. In British Columbia, we have developed treatment algorithms (Figures 1, 2, and 3) that are largely based on the newly developed tki therapy.


An approach to the management of chronic myeloid leukemia in British Columbia.

Forrest DL, Jiang X, Eaves CJ, Smith CL - Curr Oncol (2008)

Treatment algorithm for chronic myeloid leukemia (cml) in blast phase (bp). vcr = vincristine; dnr = daunorubicin; Pred = prednisone; sp2 = second stable phase; hidac = high-dose cytarabine; sd = sibling donor; Allo = allogeneic; sct = stem-cell transplantation; Mud = matched unrelated donor; pb = peripheral blood; qpcr = quantitative polymerase chain reaction.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2365478&req=5

f3-co15_2p090: Treatment algorithm for chronic myeloid leukemia (cml) in blast phase (bp). vcr = vincristine; dnr = daunorubicin; Pred = prednisone; sp2 = second stable phase; hidac = high-dose cytarabine; sd = sibling donor; Allo = allogeneic; sct = stem-cell transplantation; Mud = matched unrelated donor; pb = peripheral blood; qpcr = quantitative polymerase chain reaction.
Mentions: With the introduction of tkis (imatinib, dasatinib, nilotinib), much has changed in the standard approach to cml therapy. Before imatinib became available, most cml patients received treatment with interferon alpha, with or without cytarabine, or alternatively underwent allogeneic stem-cell transplantation if deemed eligible with a suitable donor. As compared with hydroxyurea or busulfan, interferon alpha has been shown to prolong survival; however, only a small proportion of patients (20%–30%) achieve a major cytogenetic response, and the survival benefit is largely limited to such responders 7, 8. Furthermore, interferon is associated with a number of dose-related toxicities, and most patients require dose reductions or discontinuation. For those reasons, interferon therapy has been largely replaced by the more effective and less toxic tkis. In British Columbia, we have developed treatment algorithms (Figures 1, 2, and 3) that are largely based on the newly developed tki therapy.

Bottom Line: With the introduction of the tyrosine kinase inhibitor (tki) imatinib mesylate, the treatment outcomes for patients with cml have improved markedly, and hematopoietic stem-cell transplantation is no longer routinely offered as first-line therapy for most patients in chronic phase.However, resistance to tki therapy is increasingly being recognized, and alternative therapy is needed for this group of patients.In addition, the development of models predicting response to tki therapy is desired, so that appropriate treatment strategies can be used for individual patients.The present report serves to outline the approach to the treatment of cml in British Columbia and to highlight areas of ongoing research.

View Article: PubMed Central - PubMed

Affiliation: Leukemia/BMT Program of BC, Division of Hematology, General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, BC. dforrest@bccancer.bc.ca

ABSTRACT
Chronic myeloid leukemia (cml) is a myeloproliferative disorder whose therapy has changed dramatically since the late 1990s. With the introduction of the tyrosine kinase inhibitor (tki) imatinib mesylate, the treatment outcomes for patients with cml have improved markedly, and hematopoietic stem-cell transplantation is no longer routinely offered as first-line therapy for most patients in chronic phase.However, resistance to tki therapy is increasingly being recognized, and alternative therapy is needed for this group of patients. In addition, the development of models predicting response to tki therapy is desired, so that appropriate treatment strategies can be used for individual patients. The present report serves to outline the approach to the treatment of cml in British Columbia and to highlight areas of ongoing research.

No MeSH data available.


Related in: MedlinePlus