Chronic myelogenous/myeloid leukemia

Guilhot, F. et al., Interferon alfa-2b combined with cytarabine versus interferon alone in chronic myelogenous leukemia. French Chronic Myeloid Leukemia Study Group, N. Engl. 

Sawyers CL, Hochhaus A, Feldman E et al. Imatinib induces hematologic and cytogenetic responses in patients with chronic myelogenous leukemia in myeloid blast crisis results of a phase II study. B/ooc/2002 99 3530-3539. 

Cortes J, Guilhot F, Rosti Get al. Dasatinib (SPRYCEL) in patients (pts) with chronic myelogenous leukemia in aeeelerated phase (AP-CML) that is imatinib-resistant (TM-R) or intolerant (IM-I) updated results of the CA180-005 START-A phase 11 study (Abstract 2160). Blood 2006 108 613a. Cortes J, Rousselot R Kim DW et al. Dasatinib induces complete hematologic and cytogenetic responses in patients with imatinib-resistant or -intolerant chronic myeloid leukemia in blast crisis. Blood 2007 109 3207-3213. 

Advice for treatment decisions based on specific genetic conditions were found in four Pis, namely that prolastin (a 1-proteinase inhibitor) is not indicated in patients with certain otl -antitrypsin deficiency phenotypes, trastuzumab indicated only in patients with overexpression of the HER2 protein, tretinoin, and imatinib are to be given only in patients with either a specific subtype of acute myelogenous leukemia or Philadelphia chromosome-positive chronic myeloid leukemia, respectively. 

Chronic myelogenous leukemia, a form of leukemia characterized by the increased and umegulated growth of predominantly myeloid cells in the bone marrow and the accumulation of these cells in the blood... 

Rapid exacerbation (1-21 days) or delayed (3-38 months) de novo appearance of immune hemolytic anemia has been reported after initiation of interferon alfa treatment in nine patients with lymphoproliferative disorders (220). However, this rare event was identified in only 1% of 581 patients receiving interferon alfa alone or as part of a chemotherapeutic regimen for chronic myelogenous leukemia (221). A mechanism close to that observed with alpha-methyldopa has been thought to be involved (208). The direct antiglobulin test was positive in 32% of 28 chronic myeloid leukemia patients after a median of 1 year of treatment with interferon alfa (222). 

Chronic myelogenous leukemia may progress through several clinical phases. Most patients are diagnosed with CML in chronic phase. CML may then progress to accelerated phase and finally to blast crisis (either lymphoid or myeloid), which resembles acute leukemia and may be difficult to treat. 

Chronic myelogenous leukemia is a clonal hematopoietic stem disorder characterized by excess numbers of myeloid cells that, over time, lose the capacity for terminal differentiation. A series of discoveries led to the identihca-tion of the BCR-ABL tyrosine kinase as the cause of the disease, and this provided the impetus for the development of specihc agents that target this abnormality. This has also led to improved methods for diagnosis and molecular monitoring of patients with the disease. 

Abl tyrosine kinase <1> (present in 95% of patients with chronic myelogenous leukemia, CML [39]) [39] adhesion-related kinase agammaglobulinaemia tyrosine kinase amylovoran biosynthesis membrane-associated protein amsA anaplastic lymphoma kinase B ceU progenitor kinase B lymphocyte kinase B-cell/myeloid kinase BCR-ABL tyrosine kinase BMK BPK... 

Fig. 6.1.1. Indications of autologous, allogeneic or syngeneic hematopoietic transplantation at the Hospital de la Santa Creu i Sant Pau in Barcelona. (AA, Aplastic anemia ALL, acute lymphoblastic leukemia AML, acute myeloid leukemia CLL, chronic lymphocytic leukemia CML, chronic myelogenous leukemia HD, Hodgkin s disease MDS, myelodysplastic syndrome MM, multiple myeloma NHL, non-Hodgkin s lymphoma)...

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