Chapter 104. Acute and Chronic Myeloid Leukemia (Part 13)

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Chronic Myelogenous Leukemia: Treatment The therapy of CML is changing rapidly because we have a proven curative treatment (allogeneic transplantation) that has significant toxicity and a new targeted treatment (imatinib) with excellent outcome based on 5-year follow-up data. Therefore, physician experience and patient preference must be factored into the treatment selection process. Discussion of both treatment options with a patient is indicated. The decision should focus on the outcomes, risks, and toxicities of the various approaches. At present, the goal of therapy in CML is to achieve prolonged, durable, nonneoplastic, nonclonal hematopoiesis, which entails the eradication of any residual cells containing the...

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Chapter 104. Acute and Chronic Myeloid Leukemia (Part 13) Chronic Myelogenous Leukemia: Treatment The therapy of CML is changing rapidly because we have a proven curative treatment (allogeneic transplantation) that has significant toxicity and a new targeted treatment (imatinib) with excellent outcome based on 5-year follow-up data. Therefore, physician experience and patient preference must be factored into the treatment selection process. Discussion of both treatment options with a patient is indicated. The decision should focus on the outcomes, risks, and toxicities of the various approaches. At present, the goal of therapy in CML is to achieve prolonged, durable, nonneoplastic, nonclonal hematopoiesis, which entails the eradication of any
residual cells containing the BCR/ABL transcript. Hence the goal is complete molecular remission and cure. A proposed imatinib treatment algorithm for the newly diagnosed CML patient is presented in Table 104-4. Table 104-4 Imatinib Treatment Milestones for Newly Diagnosed CML Patients Proposed Course of Actiona Transplantation from an HLA- Continue sameb or compatible (related or unrelated) increase dosec donor, dasatinib, new drugs Time, Milestones months 3 No complete hematologic Complete remission hematologic remissionb,d
6 No cytogenetic remission Any cytogenetic remissionc 12 Minore or no cytogenetic Completeb,f or remission partialc,g cytogenetic remission 18 Partial, minor, or no Complete cytogenetic remission cytogenetic remissionb Anytime Loss of previously achieved hematologic, cytogenetic, or molecular remission a Nutritional Comprehensive Cancer Network, Chronic myelogenous leukemia. b Denotes that at the indicated milestones, patients should stay on the same dose. c Denotes that at the indicated milestones, for patients on 400 mg/d, one can either continue the same or increase the dose to a maximum of 600–800 mg, as
tolerated. d Complete hematologic remission, WBC