TREATMENT RECOMMENDATIONS FOR CHRONIC MYELOID LEUKEMIA
The first treatment of chronic myeloid leukemia (CML) included spleen x-radiation and conventional drugs, mainly Busulfan and Hydroxyurea. This therapy improved the quality of life during the chronic phase of the disease, without preventing nor significantly delaying the progression towards advanced...
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PAGEPress Publications
2014-01-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
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| Online Access: | http://www.mjhid.org/index.php/mjhid/article/view/1361 |
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| author | Michele Baccarani Fausto Castagnetti Gabriele Gugliotta Francesca Palandri Gianantonio Rosti |
| author_facet | Michele Baccarani Fausto Castagnetti Gabriele Gugliotta Francesca Palandri Gianantonio Rosti |
| author_sort | Michele Baccarani |
| collection | DOAJ |
| description | The first treatment of chronic myeloid leukemia (CML) included spleen x-radiation and conventional drugs, mainly Busulfan and Hydroxyurea. This therapy improved the quality of life during the chronic phase of the disease, without preventing nor significantly delaying the progression towards advanced phases. The introduction of allogeneic stem cell transplantation (alloSCT) marked the first important breakthrough in the evolution of CML treatment, because about 50% of the eligible patients were cured. The second breakthrough was the introduction of human recombinant interferon-alfa, able to achieve a complete cytogenetic remission in 15% to 30% of patients, with a significant survival advantage over conventional chemotherapy. At the end of the last century, about 15 years ago, all these treatments were quickly replaced by a class of small molecules targeting the tyrosine kinases (TK), which were able to induce a major molecular remission in most of the patients, without remarkable side effects, and a very prolonged life-span. The first approved TK inhibitor (TKI) was Imatinib Mesylate (Glivec or Gleevec, Novartis). Rapidly, other TKIs were developed tested and commercialized, namely Dasatinib (Sprycel, Bristol-Myers Squibb), Nilotinib (Tasigna, Novartis), Bosutinib (Busulif, Pfizer) and Ponatinib (Iclusig, Ariad). Not all these compounds are available worldwide; some of them are approved only for second line treatment, and the high prices are a problem that can limit their use. A frequent update of treatment recommendations is necessary. The current treatment goals include not only the prevention of the transformation to the advanced phases and the prolongation of survival, but also a length of survival and of a quality of life comparable to that of non-leukemic individuals. In some patient the next ambitious step is to move towards a treatment-free remission. The CML therapy, the role of alloSCT and the promising experimental strategies are reviewed in the context of the new therapeutic goals. |
| format | Article |
| id | doaj-art-dc3219c289654b8da64c95cdeb26a851 |
| institution | DOAJ |
| issn | 2035-3006 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Mediterranean Journal of Hematology and Infectious Diseases |
| spelling | doaj-art-dc3219c289654b8da64c95cdeb26a8512025-08-20T02:44:02ZengPAGEPress PublicationsMediterranean Journal of Hematology and Infectious Diseases2035-30062014-01-0161e2014005e201400510.4084/mjhid.2014.0051121TREATMENT RECOMMENDATIONS FOR CHRONIC MYELOID LEUKEMIAMichele Baccarani0Fausto Castagnetti1Gabriele Gugliotta2Francesca Palandri3Gianantonio Rosti4Department of Hematology and Oncology “L. and A. Seràgnoli"; University of Bologna; Bologna, ItalyInstitute of Hematology “L. & A. Seràgnoli”; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna, ItalyInstitute of Hematology “L. & A. Seràgnoli”; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna, ItalyInstitute of Hematology “L. & A. Seràgnoli”; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna, ItalyInstitute of Hematology “L. & A. Seràgnoli”; Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna, ItalyThe first treatment of chronic myeloid leukemia (CML) included spleen x-radiation and conventional drugs, mainly Busulfan and Hydroxyurea. This therapy improved the quality of life during the chronic phase of the disease, without preventing nor significantly delaying the progression towards advanced phases. The introduction of allogeneic stem cell transplantation (alloSCT) marked the first important breakthrough in the evolution of CML treatment, because about 50% of the eligible patients were cured. The second breakthrough was the introduction of human recombinant interferon-alfa, able to achieve a complete cytogenetic remission in 15% to 30% of patients, with a significant survival advantage over conventional chemotherapy. At the end of the last century, about 15 years ago, all these treatments were quickly replaced by a class of small molecules targeting the tyrosine kinases (TK), which were able to induce a major molecular remission in most of the patients, without remarkable side effects, and a very prolonged life-span. The first approved TK inhibitor (TKI) was Imatinib Mesylate (Glivec or Gleevec, Novartis). Rapidly, other TKIs were developed tested and commercialized, namely Dasatinib (Sprycel, Bristol-Myers Squibb), Nilotinib (Tasigna, Novartis), Bosutinib (Busulif, Pfizer) and Ponatinib (Iclusig, Ariad). Not all these compounds are available worldwide; some of them are approved only for second line treatment, and the high prices are a problem that can limit their use. A frequent update of treatment recommendations is necessary. The current treatment goals include not only the prevention of the transformation to the advanced phases and the prolongation of survival, but also a length of survival and of a quality of life comparable to that of non-leukemic individuals. In some patient the next ambitious step is to move towards a treatment-free remission. The CML therapy, the role of alloSCT and the promising experimental strategies are reviewed in the context of the new therapeutic goals.http://www.mjhid.org/index.php/mjhid/article/view/1361Chronic Myeloid LeukemiaTreatment recommendationsTyrosine kinase inhibitors |
| spellingShingle | Michele Baccarani Fausto Castagnetti Gabriele Gugliotta Francesca Palandri Gianantonio Rosti TREATMENT RECOMMENDATIONS FOR CHRONIC MYELOID LEUKEMIA Mediterranean Journal of Hematology and Infectious Diseases Chronic Myeloid Leukemia Treatment recommendations Tyrosine kinase inhibitors |
| title | TREATMENT RECOMMENDATIONS FOR CHRONIC MYELOID LEUKEMIA |
| title_full | TREATMENT RECOMMENDATIONS FOR CHRONIC MYELOID LEUKEMIA |
| title_fullStr | TREATMENT RECOMMENDATIONS FOR CHRONIC MYELOID LEUKEMIA |
| title_full_unstemmed | TREATMENT RECOMMENDATIONS FOR CHRONIC MYELOID LEUKEMIA |
| title_short | TREATMENT RECOMMENDATIONS FOR CHRONIC MYELOID LEUKEMIA |
| title_sort | treatment recommendations for chronic myeloid leukemia |
| topic | Chronic Myeloid Leukemia Treatment recommendations Tyrosine kinase inhibitors |
| url | http://www.mjhid.org/index.php/mjhid/article/view/1361 |
| work_keys_str_mv | AT michelebaccarani treatmentrecommendationsforchronicmyeloidleukemia AT faustocastagnetti treatmentrecommendationsforchronicmyeloidleukemia AT gabrielegugliotta treatmentrecommendationsforchronicmyeloidleukemia AT francescapalandri treatmentrecommendationsforchronicmyeloidleukemia AT gianantoniorosti treatmentrecommendationsforchronicmyeloidleukemia |