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Chronic Myeloid Leukemia
This book provides state-of-the-art reviews of key issues and recent developments relating to chronic myeloid leukemia (CML), acquainting the reader with advances in research, treatment, and promotion of public health. Among the management topics addressed are the choices, advantages, and pitfalls of first-, second-, and third-line treatments; the European LeukemiaNet recommendations; management of adverse effects of tyrosine kinase inhibitors (TKI); management of CML blast crisis; management of pregnancy in the context of CML; the role of hematopoietic cell transplantation; the current experience with TKI discontinuation; and the value of interferon α in improving the outcome of TKI treatment. Various aspects of relevance to treatment outcome are discussed, including prognostic scores, molecular monitoring (principles and interlaboratory standardization), and response-related predictors of survival. Furthermore, updates are provided on the increasing prevalence of CML and its implications and on the changing cost of care for CML, taking into account the forthcoming impact of availability of generic imatinib.
Assessment of Imatinib as First-line Treatment of Chronic Myeloid Leukemia: 10-year Survival Results of the Randomized CML Study IV and Impact of Non-CML Determinants
Abstract: Chronic myeloid leukemia (CML)-study IV was designed to explore whether treatment with imatinib (IM) at 400 mg/day (n=400) could be optimized by doubling the dose (n=420), adding interferon (IFN) (n=430) or cytarabine (n=158) or using IM after IFN-failure (n=128). From July 2002 to March 2012, 1551 newly diagnosed patients in chronic phase were randomized into a 5-arm study. The study was powered to detect a survival difference of 5% at 5 years. After a median observation time of 9.5 years, 10-year overall survival was 82%, 10-year progression-free survival was 80% and 10-year relative survival was 92%. Survival between IM400 mg and any experimental arm was not different. In a mult...
Defining Therapy Goals for Major Molecular Remission in Chronic Myeloid Leukemia: Results of the Randomized CML Study IV
Abstract: Major molecular remission (MMR) is an important therapy goal in chronic myeloid leukemia (CML). So far, MMR is not a failure criterion according to ELN management recommendation leading to uncertainties when to change therapy in CML patients not reaching MMR after 12 months. At monthly landmarks, for different molecular remission status Hazard ratios (HR) were estimated for patients registered to CML study IV who were divided in a learning and a validation sample. The minimum HR for MMR was found at 2.5 years with 0.28 (compared to patients without remission). In the validation sample, a significant advantage for progression-free survival (PFS) for patients in MMR could be detected...
High-risk Additional Chromosomal Abnormalities at Low Blast Counts Herald Death by CML
Abstract: Blast crisis is one of the remaining challenges in chronic myeloid leukemia (CML). Whether additional chromosomal abnormalities (ACAs) enable an earlier recognition of imminent blastic proliferation and a timelier change of treatment is unknown. One thousand five hundred and ten imatinib-treated patients with Philadelphia-chromosome-positive (Ph+) CML randomized in CML-study IV were analyzed for ACA/Ph+ and blast increase. By impact on survival, ACAs were grouped into high risk (+8, +Ph, i(17q), +17, +19, +21, 3q26.2, 11q23, −7/7q abnormalities; complex) and low risk (all other). The presence of high- and low-risk ACAs was linked to six cohorts with different blast levels (1%, 5%...
Chronic Myeloid Leukemia
This text, containing contributions from an international team of experts in chronic myeloid leukaemia, examines the advances being made in our understanding of this disease, and the implications these have for its management. Topics covered include a review of molecular and cellular biology, discussion of conventional chemotherapy and interferon therapy, and developments in allografting and autografting.
Chronic Myeloid Leukemia
This book provides state-of-the-art reviews of key issues and recent developments relating to chronic myeloid leukemia (CML), acquainting the reader with advances in research, treatment, and promotion of public health. Among the management topics addressed are the choices, advantages, and pitfalls of first-, second-, and third-line treatments; the European LeukemiaNet recommendations; management of adverse effects of tyrosine kinase inhibitors (TKI); management of CML blast crisis; management of pregnancy in the context of CML; the role of hematopoietic cell transplantation; the current experience with TKI discontinuation; and the value of interferon α in improving the outcome of TKI treatment. Various aspects of relevance to treatment outcome are discussed, including prognostic scores, molecular monitoring (principles and interlaboratory standardization), and response-related predictors of survival. Furthermore, updates are provided on the increasing prevalence of CML and its implications and on the changing cost of care for CML, taking into account the impact of availability of generic imatinib.
