Chronic myelogenous leukemia medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
Overview
Medical therapies for chronic myelogenous leukemia (CML) include chemotherapy, stem cell transplant , and/or biological therapy. With improved understanding of the nature of the bcr-abl protein and its action as a tyrosine kinase, targeted therapies have been developed (the first of which was imatinib mesylate) which specifically inhibit the activity of theBCR-ABL protein. These tyrosine kinase inhibitors can induce complete remissions in chronic myelogenous leukemia, confirming the central importance of BCR-ABL as the cause of chronic myelogenous leukemia.[1][2][3][4]
Medical Therapy
Medical therapy depends on the phase of chronic myelogenous leukemia.
Chronic Phase
- Targeted therapy[5]
- Targeted therapy is the primary treatment for most people with chronic myelogenous leukemia in the chronic phase. The types of targeted therapy used are:
-
- Standard first-line therapy
-
- May be given as a first-line therapy
- May also be used if a person cannot tolerate imatinib or the CML is resistant to imatinib
-
- May be given as a first-line therapy
- May also be used if a person cannot tolerate imatinib or the CML is resistant to imatinib
- Stem cell transplant
- Stem cell transplant may be offered for CML in the chronic phrase.
- It is sometimes used as a primary treatment option for younger people who have an HLA-matched donor.
- It is a treatment option for some people who do not achieve a complete response, develop resistance to or relapse with imatinib.
- A reduced-intensity transplant may be an option for older people who may not tolerate a standard transplant.
- The chemotherapy or radiation used to prepare for a stem cell transplant is less intense than that used for a standard allogeneic transplant.
- Biological therapy
- Biological therapy may be offered for chronic stage CML. Biological therapy can be used alone or in combination with chemotherapy.
- The most common biological therapy used is interferon alfa (Intron A, Roferon A).
- Interferon alfa may be used for people who cannot tolerate, or whose CML is resistant to, imatinib.
- Chemotherapy
- Chemotherapy may be offered for CML in the chronic phase. The types of chemotherapy used are:
- Hydroxyurea (Hydrea, Apo-hydroxyurea, Gen-hydroxyurea)
- Cytarabine (Cytosar)
- May be used in combination with interferon alfa
- Busulfan (Myleran [oral], Busulfex [intravenous])
Accelerated Phase
- Stem cell transplant[5]
- Allogeneic transplant.
- Clinicians usually prefer that the leukemia returns to the chronic phase or is controlled before the transplant.
- Sometimes an autologous transplant.
- A reduced-intensity transplant may be an option for older people who may not tolerate a standard transplant.
- The chemotherapy or radiation used to prepare for a stem cell transplant is less intense than that used for a standard allogeneic transplant.
- Targeted therapy
- Targeted therapy with a tyrosine kinase inhibitor may be offered during the accelerated phase of CML. For those already taking targeted therapy, the dose may be increased. The types of targeted therapy used are:
- Biological therapy
- Interferon alfa
- Cytarabine
- Chemotherapy
- Chemotherapy may be offered for CML in the accelerated phase. The types of chemotherapy used are:
- Cytarabine
- HDAC (high-dose cytarabine)
- Hydroxyurea
- Busulfan
- Busulfex
Blast Phase
- Targeted therapy[5]
- Targeted therapy with a tyrosine kinase inhibitor may be offered for CML in the blast phase. For those already taking targeted therapy, the dose may be increased. The types of targeted therapy used are:
- The most common drugs used when the leukemia cells look like AML include:
- Cytarabine
- HDAC (high-dose cytarabine)
- An anthracycline, such as daunorubicin or doxorubicin
- Tُhioguanine
- Hydroxyurea
- The most common drugs used when the leukemia cells look like ALL include the drugs listed above as well as:
- There is increased risk of spread to the central nervous system (CNS) during the blast phase, so the following chemotherapy drugs may be given into the spinal fluid (intrathecal):
- Stem cell transplant
- Allogeneic stem cell transplant
- Radiation therapy may be offered for blast phase CML for:
- Spleenomegaly
- Bone pain
Relapsed or Refractory Chronic Myelogenous
- Targeted therapy with a tyrosine kinase inhibitor may be offered for relapsed or refractory CML. For those already taking targeted therapy, the dose may be increased. The types of targeted therapy used are:
Supportive Therapy
- Antibiotics and Antifungals
- Blood products
- Packed red blood cells
- Platelets
- Fresh frozen plasma
- Cryoprecipitate
- Growth factors
- Granulocyte colony-stimulating factors (G-CSF)
References
- ↑ National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/types/leukemia/hp/cml-treatment-pdq#section/_19
- ↑ Jabbour E, Kantarjian H (May 2014). "Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management". Am. J. Hematol. 89 (5): 547–56. doi:10.1002/ajh.23691. PMID 24729196.
- ↑ Thompson PA, Kantarjian HM, Cortes JE (October 2015). "Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015". Mayo Clin. Proc. 90 (10): 1440–54. doi:10.1016/j.mayocp.2015.08.010. PMC 5656269. PMID 26434969.
- ↑ Faderl S, Talpaz M, Estrov Z, Kantarjian HM (August 1999). "Chronic myelogenous leukemia: biology and therapy". Ann. Intern. Med. 131 (3): 207–19. PMID 10428738.
- ↑ 5.0 5.1 5.2 Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/treatment/chronic/?region=ab