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Advanced CML: therapeutic options for patients in accelerated and blast phases.
J Natl Compr Canc Netw 2008; 6 Suppl 2:S31-S36JN

Abstract

Tyrosine kinase inhibitor (TKI) therapy has impacted the natural course of chronic myelogenous leukemia (CML), because patients diagnosed as having chronic-phase disease can experience long-lasting responses. However, for patients with advanced CML (accelerated and blast phases), the efficacy of all current therapies is reduced. For these patients, allogeneic stem cell transplantation remains the preferred treatment if a donor is available, although TKIs play a valuable role as a bridging therapy. For patients with accelerated-phase CML, imatinib, dasatinib, and nilotinib have been shown to produce meaningful rates of hematologic and cytogenetic response. Imatinib and dasatinib are also approved for blast-phase CML. Studies with the newer agents have involved heavily pretreated patients; however, response rates have been at least comparable to those achieved with imatinib in previous studies. Therefore, these newer, more potent TKIs will probably be more likely to induce a deep response in previously untreated patients. Moreover, because fewer mechanisms appear to exist for secondary resistance to dasatinib and nilotinib, reducing the potential for disease to escape TKI therapy, these agents may result in improved longer-term outcomes. However, BCR-ABL-independent pathways may also become more important, indicating that other therapeutic targets may also have a future role in managing patients with advanced CML.

Authors+Show Affiliations

Division of Hematology/Oncology, University of California, San Francisco, San Francisco, California, 94143, USA. nshah@medicine.ucsf.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18397679

Citation

Shah, Neil P.. "Advanced CML: Therapeutic Options for Patients in Accelerated and Blast Phases." Journal of the National Comprehensive Cancer Network : JNCCN, vol. 6 Suppl 2, 2008, pp. S31-S36.
Shah NP. Advanced CML: therapeutic options for patients in accelerated and blast phases. J Natl Compr Canc Netw. 2008;6 Suppl 2:S31-S36.
Shah, N. P. (2008). Advanced CML: therapeutic options for patients in accelerated and blast phases. Journal of the National Comprehensive Cancer Network : JNCCN, 6 Suppl 2, pp. S31-S36.
Shah NP. Advanced CML: Therapeutic Options for Patients in Accelerated and Blast Phases. J Natl Compr Canc Netw. 2008;6 Suppl 2:S31-S36. PubMed PMID: 18397679.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advanced CML: therapeutic options for patients in accelerated and blast phases. A1 - Shah,Neil P, PY - 2008/8/9/pubmed PY - 2008/9/10/medline PY - 2008/8/9/entrez SP - S31 EP - S36 JF - Journal of the National Comprehensive Cancer Network : JNCCN JO - J Natl Compr Canc Netw VL - 6 Suppl 2 N2 - Tyrosine kinase inhibitor (TKI) therapy has impacted the natural course of chronic myelogenous leukemia (CML), because patients diagnosed as having chronic-phase disease can experience long-lasting responses. However, for patients with advanced CML (accelerated and blast phases), the efficacy of all current therapies is reduced. For these patients, allogeneic stem cell transplantation remains the preferred treatment if a donor is available, although TKIs play a valuable role as a bridging therapy. For patients with accelerated-phase CML, imatinib, dasatinib, and nilotinib have been shown to produce meaningful rates of hematologic and cytogenetic response. Imatinib and dasatinib are also approved for blast-phase CML. Studies with the newer agents have involved heavily pretreated patients; however, response rates have been at least comparable to those achieved with imatinib in previous studies. Therefore, these newer, more potent TKIs will probably be more likely to induce a deep response in previously untreated patients. Moreover, because fewer mechanisms appear to exist for secondary resistance to dasatinib and nilotinib, reducing the potential for disease to escape TKI therapy, these agents may result in improved longer-term outcomes. However, BCR-ABL-independent pathways may also become more important, indicating that other therapeutic targets may also have a future role in managing patients with advanced CML. SN - 1540-1405 UR - https://www.unboundmedicine.com/medline/citation/18397679/Advanced_CML:_therapeutic_options_for_patients_in_accelerated_and_blast_phases_ L2 - https://medlineplus.gov/chronicmyeloidleukemia.html DB - PRIME DP - Unbound Medicine ER -