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 include chemotherapy, stem cell transplant , and/or biological therapy.
Medical Therapy
Medical therapy depends on the phase of chronic myelogenous leukemia.
Chronic Phase
- Targeted therapy[1]
- Targeted therapy is the primary treatment for most people with CML in the chronic phase. The types of targeted therapy used are:
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- Standard first-line therapy
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- 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
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- 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[1]
- 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[1]
- 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:
There are different types of treatment for patients with chronic myelogenous leukemia
Different types of treatment are available for patients with chronic myelogenous leukemia (CML). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Leukapheresis
It is also known as a peripheral blood stem cell transplant, with stem cell cryopreservation (frozen storage) prior to any other treatment. The patient's blood is passed through a machine that removes the stem cells and then returns the blood to the patient. Leukapheresis usually takes 3 or 4 hours to complete. The stem cells may or may not be treated with drugs to kill any cancer cells. The stem cells then are stored until they are transplanted back into the patient.
Tyrosine kinase inhibitor therapy
A drug called imatinib mesylate is used as initial treatment for certain types of chronic myelogenous leukemia in newly diagnosed patients. It blocks an enzyme called tyrosine kinase that causes stem cells to develop into more white blood cells (granulocytes or blasts) than the body needs. Another tyrosine kinase inhibitor called dasatinib is used to treat patients with certain types of CML that have progressed, and is being studied as an initial treatment.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Biologic therapy
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
High-dose chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
Donor lymphocyte infusion (DLI)
Donor lymphocyte infusion (DLI) is a cancer treatment that may be used after stem cell transplant. Lymphocytes (a type of white blood cell) from the stem cell transplant donor are removed from the donor’s blood and may be frozen for storage. The donor’s lymphocytes are thawed if they were frozen and then given to the patient through one or more infusions. The lymphocytes see the patient’s cancer cells as not belonging to the body and attack them.
References
- ↑ 1.0 1.1 1.2 Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/treatment/chronic/?region=ab