chronic%20myeloid%20leukemia
CHRONIC MYELOID LEUKEMIA

Chronic myelogenous leukemia (CML) is a malignant myeloid disorder characterized by the presence of a distinctive cytogenetic abnormality known as the Philadelphia chromosome.

Exposure to ionizing radiation is the only known risk factor with median presentation at age >50 years old.

Three phases of the disorder are chronic, accelerated and blast.

Choice of therapy is influenced by age, availability of a donor, comorbidities and phase of CML.

Hematopoietic Stem Cell Transplantation (HSCT)

  • Patients are first treated with a preparative or conditioning regimen (eg chemotherapy or radiation therapy or both) followed by infusion of hematopoietic progenitor/stem cells
  • Parameters for HCT application depends on the patient’s disease and stage of the disease, cell donor and the source of the progenitor cells

Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HCT)

  • The indications and outcomes of allo-HCT will depend on the age and comorbidities of the patient, donor type and transplant center
  • Progenitor cells are collected from healthy persons and are used to treat hematologic neoplasms, nonmalignant marrow disorders (eg acquired and inherited), and inborn errors of metabolism
  • First-line treatment option for patients diagnosed with BP-CML at initial evaluation
  • May be considered in CP-CML patients deemed cytogenetically and molecularly unresponsive to multiple TKI therapy or those with T315I mutation unresponsive to Ponatinib therapy
  • May be considered in patients with AP unresponsive to TKI therapy, BP following induction of TKI, relapsed disease, resistant to multiple TKIs and intolerant to TKI

Monitoring Response with Allo-HCT

  • A qPCR assay that is positive ≥18 months after transplant is associated with a lower risk of relapse compared to those with positive qPCR assay at 6-12 months post-transplant
  • In a patient with prior accelerated or blast phase CML who attained complete cytogenetic response (CCyR) and is negative for BCR-ABL1, TKI therapy for at least 1 year should be considered
  • In a patient who attained CCyR who is positive for BCR-ABL1 or patients not in CCyR or is in relapse, options to undergo treatment with TKIs with or without donor lymphocyte infusion (DLI) or Omacetaxine, or may be enrolled in a clinical trial should be discussed

Management of Post-transplant Relapse

  • Donor lymphocyte infusion (DLI)
    • Induces effective durable molecular remissions in patients with relapsed CML following allo-HCT
      • The probability of survival at 3 years is better
    • More effective in patients with chronic phase relapse
    • Complications such as graft-vs-host disease (GVHD), susceptibility to infections and immunosuppression may develop
    • Ways on how to reduce the incidence of GVHD:
      • Improve the methods that detects BCR-ABL1 transcripts
      • Develop reduced-intensity conditioning regimens
      • Modify the delivery of lymphocytes with the depletion of CD8+ cells
      • Escalate cell dosage regimen
      • Very low-dose DLI and IFN-alpha combination may help reduce GVHD
  • Imatinib
    • Induces durable remissions in patients with relapse in all phases of CML following allo-HCT
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Oncology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
6 days ago
Regular practice of yoga postures confers benefits for glucose control, oxidative stress, inflammatory response, and sleep quality in patients with type 2 diabetes, a study has found.
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
09 Jan 2021
Women with central adiposity, regardless of menopausal status, are at risk of developing breast cancer, according to a study.