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.

Surgical Intervention

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
Yesterday
Routinely used for treating cardiovascular diseases, statins have been shown to benefit other conditions, and new evidence suggests that using the drug at high intensity reduces the risk of hip or knee replacement, an effect that may be specific to rheumatoid arthritis.
Pearl Toh, 29 Jun 2020
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.
30 Jun 2020
Patients with psoriatic arthritis (PsA) often suffer from liver abnormalities, which are associated with higher body mass index (BMI), daily consumption of alcohol, more severe disease, and some therapies, according to a recent study.
Christina Lau, 5 days ago

Pembrolizumab in combination with chemotherapy significantly improves progression-free survival (PFS) vs chemotherapy alone in patients with previously untreated, locally recurrent inoperable or metastatic triple-negative breast cancer (TNBC), results of the KEYNOTE-355 study have shown.