Chronic myeloid leukemia (CML) is a stem cell disorder caused by the Philadelphia chromosome, which results from the fusion of the BCR gene on chromosome 22 and the ABL gene on chromosome 9. This fusion produces the BCR-ABL protein which exhibits uncontrolled tyrosine kinase activity, driving excessive proliferation of CML cells. CML progresses through chronic, accelerated and blast crisis phases as additional genetic mutations accumulate. Tyrosine kinase inhibitors (TKIs) target the BCR-ABL protein and have significantly improved survival, with a 10-year survival of 85% with TKI therapy. Monitoring response through cytogenetics, FISH and molecular testing guides treatment decisions such as changing or adding other TKIs.
Learning Objectives:
Introduction
Definition of CML
Philadelphia Chromosome
Normal Granulopoiesis
Pathogenesis of CML
Aetiology
Incidence
Clinical Features
Phases of CML
Lab Diagnosis of CML
Course & Prognosis
Differential Diagnosis
Brief Overview of Treatment
Chronic myelogenous leukemia (CML) - pluripotential stem cell disease
A malignancy the treatment of which has been revolutionised over the last decade.
Here is a comprehensive discussion on the disease
Learning Objectives:
Introduction
Definition of CML
Philadelphia Chromosome
Normal Granulopoiesis
Pathogenesis of CML
Aetiology
Incidence
Clinical Features
Phases of CML
Lab Diagnosis of CML
Course & Prognosis
Differential Diagnosis
Brief Overview of Treatment
Chronic myelogenous leukemia (CML) - pluripotential stem cell disease
A malignancy the treatment of which has been revolutionised over the last decade.
Here is a comprehensive discussion on the disease
Expert Guidance on Current Standards and New Directions in Newly Diagnosed Mu...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
Presented by leading expert Urvi Shah, MD, Assistant Attending in the Myeloma Service at Memorial Sloan Kettering Cancer Center, this slide deck will explore guidance on current standards and new directions in newly diagnosed multiple myeloma.
STATEMENT OF NEED
An estimated 35,730 new cases of multiple myeloma are diagnosed in the United States annually, and 12,590 people die of the disease (Siegel et al, 2023). Characterized by clonal proliferation of malignant plasma cells in the bone marrow, multiple myeloma is associated with anemia, renal insufficiency, bone destruction, and hypercalcemia, all of which significantly impact patients’ quality of life. The development of novel therapies and combinations in recent years, including anti-CD38 antibodies, has provided numerous therapeutic options for newly diagnosed multiple myeloma. However, the optimal selection of induction therapy and subsequent treatment sequencing for individual patients remains a challenge. Additionally, factors including age, frailty, comorbidities, transplant eligibility, treatment-related toxicities, and supportive care needs complicate treatment decisions (Costello et al, 2022). This hematology/oncology fellows lecture series will explore expert guidance on current standards and new directions in newly diagnosed multiple myeloma.
TARGET AUDIENCE
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with multiple myeloma.
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Assess guideline-recommended treatment combination and sequencing strategies in NDMM
Evaluate the role of minimal residual disease (MRD) assessment in NDMM treatment
Review the mechanism of action, efficacy, and safety of anti-CD38 monoclonal antibodies in the treatment of NDMM
Discuss strategies to monitor and manage treatment-related toxicities and optimize survivorship care
chronic myeloid leukemia, CML, epidemiology, BCR ABL1 gene, philadelphia chromosome, t(9;22), CML incidence, etiology of CML, pathophysiology of CML, phases of CML, treatment of CML, Allogenic stem cell transplant, TKI therapy for CML, Sokal index for CML,
A myeloprolifrative stem cell disorder resulting in
Proliferation of all haematopoietic lineages but
manifestation Predominantly in the granulocytic series.
The disease occurs chiefly between 30 and 80 years, with
A peak incidence at the 55 years.
*accounts for 20% of all leukaemis.
*found in all races.
*the aetiology is unknown.
Expert Guidance on Current Standards and New Directions in Newly Diagnosed Mu...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
Presented by leading expert Urvi Shah, MD, Assistant Attending in the Myeloma Service at Memorial Sloan Kettering Cancer Center, this slide deck will explore guidance on current standards and new directions in newly diagnosed multiple myeloma.
STATEMENT OF NEED
An estimated 35,730 new cases of multiple myeloma are diagnosed in the United States annually, and 12,590 people die of the disease (Siegel et al, 2023). Characterized by clonal proliferation of malignant plasma cells in the bone marrow, multiple myeloma is associated with anemia, renal insufficiency, bone destruction, and hypercalcemia, all of which significantly impact patients’ quality of life. The development of novel therapies and combinations in recent years, including anti-CD38 antibodies, has provided numerous therapeutic options for newly diagnosed multiple myeloma. However, the optimal selection of induction therapy and subsequent treatment sequencing for individual patients remains a challenge. Additionally, factors including age, frailty, comorbidities, transplant eligibility, treatment-related toxicities, and supportive care needs complicate treatment decisions (Costello et al, 2022). This hematology/oncology fellows lecture series will explore expert guidance on current standards and new directions in newly diagnosed multiple myeloma.
TARGET AUDIENCE
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with multiple myeloma.
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Assess guideline-recommended treatment combination and sequencing strategies in NDMM
Evaluate the role of minimal residual disease (MRD) assessment in NDMM treatment
Review the mechanism of action, efficacy, and safety of anti-CD38 monoclonal antibodies in the treatment of NDMM
Discuss strategies to monitor and manage treatment-related toxicities and optimize survivorship care
chronic myeloid leukemia, CML, epidemiology, BCR ABL1 gene, philadelphia chromosome, t(9;22), CML incidence, etiology of CML, pathophysiology of CML, phases of CML, treatment of CML, Allogenic stem cell transplant, TKI therapy for CML, Sokal index for CML,
A myeloprolifrative stem cell disorder resulting in
Proliferation of all haematopoietic lineages but
manifestation Predominantly in the granulocytic series.
The disease occurs chiefly between 30 and 80 years, with
A peak incidence at the 55 years.
*accounts for 20% of all leukaemis.
*found in all races.
*the aetiology is unknown.
Molecular monitoring of CML patients and aims of treatment and management with illustration of the mechanism of action of different drugs (Tyrosine Kinase inhibitors) used in the management of the chronic myeloid leukemia (CML)
plastic anemia is a rare bone marrow failure disorder in which the bone marrow stops making enough blood cells (red blood cells, white blood cells, and ...
Approach to evaluating and treating Chronic Heart Failure and Acute Heart Failure
Reference: Harrison’s Principles of internal medicine Harrison's 21st Ed (2022)
download notes of the presentation and study with its print out
Approach to evaluating and treating Chronic Heart Failure and Acute Heart Failure
Reference: Harrison’s Principles of internal medicine Harrison's 21st Ed (2022)
LECTURE ON ATRIAL FIBRILLATION TO 9TH TERM MEDICAL STUDENTS REFERENCES: DAVIDSON(2018) HARRISON 20TH ED OF MEDICINE AND 2020 EUROPEAN HEART GUIDELINES ON AF
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Pulmonary embolism - Notes are made from textbook of Internal medicine to assist medical students and residents to grasp subject in totality. Resources: Harrison's 20thEd, ESC 2019 guidelines on PE
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
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comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Chronic Myeloid Leukemia - notes 2022
1. CHRONIC MYELOID LEUKEMIA
(Notes from Harrison’s 20th
Ed by Col Bharat Malhotra)
DEFINE
Proliferation of Primitive Myeloid Stem Cells
Maturation of cells proceed fairly.
Chronic myeloid leukaemia (CML) is a clonal myeloproliferative
stem cell disorder resulting in proliferation of all haematopoietic
lineages but manifesting predominantly in the granulocytic series.
The disease is driven by the BCR-ABL1 chimeric gene product, that
codes for a constitutively active tyrosine kinase, resulting from a
reciprocal balanced translocation between the long arms of
chromosomes 9 and 22, t(9;22), known as the Philadelphia
chromosome (Ph)
ETIOPATHOGENESIS
The defining characteristic of CML is the chromosome
abnormality known as thePhiladelphia (Ph) chromosome. BCR gene
on chromosome 22 fuses with ABL gene on chromosome 9. BCR-
ABL fusion gene encodes protein with tyrosine kinase activity
This BCR-ABL1 oncoprotein exhibits constitutive kinase activity
that leads to excessive proliferation and reduced apoptosis of CML
cells, endowing them with a growth advantage over their normal
counterparts.
Other rare rearrangements:
There can be rarely a Variant Ph, Masked Ph
There are no familial associations in CML.
No etiologic agents are incriminated.
Exposure to ionized radiation may increase risk.
The cause of the BCR-ABL1 molecular rearrangement is unknown
BLAST PHASE
Theevents associated with the transition of CMLfrom a chronic to
accelerated-blastic phaseare poorly understood. BCR-ABL1 itself
induces genetic instability that favors the acquisition of additional
molecular events/mutations and eventually to blastic
transformation
RESISTANCE TO TKIs
Among patients developing resistance to TKIs, several resistance
mechanisms have been observed. The most clinically relevant one
is thedevelopment of different ABL1 kinase domain mutations that
may prevent thebinding of TKIs to the catalyticsite (ATP-binding
site) of the kinase or maintain the kinase activity despite the
presence of a TKI. Morethan 100 BCR-ABL1 mutations have now
been described, many of which confer relative or absolute
resistance to imatinib. This has resulted in the development of
second-generation TKIs (i.e., dasatinib, nilotinib, bosutinib) and of
a third-generation TKI (ponatinib) with significant efficacy against
T315I, a “gatekeeper” mutation that prevents binding of and causes
resistance to all other TKIs.
SURVIVAL
Median Survival without Rx:
3-7 years (30%)
Median survival with TKI: (85%)
EPIDEMIOLOGY
Account for 15% of all leukemias.
Median age: 55-65 years
Incidence increases steeply over 40-
50 years
In children < 20 years is 3%
2. NATURAL HISTORY
The disease has 3 phases
Peripheral blood
< 5% Blast 5- 10% Blast
Basophilia
--
Bone Marrow
< 10% Blast 10-20% Blast > 20% Blast
Myeloid/ Lymphoid
-- --
Extramedullary
proliferationof blasts
in spleen, liver, lymph node,
soft tissue and becomes
refractory to Rx
Responseto Rx Unresponsive
to Rx
Transforms into acute
leukemia
SUSPECT CML IN
Massivesplenomegaly
PBS shows: Myeloproliferativedisorder, high thrombocytosis,
Full range of granulocyte precursors, usually myelocytes and
neutrophils (blast <10%)
Unexplained metabolic/oncology emergencies
CLINICAL FEATURES
Chronic Phase
Indolent or chronic onset - usually asymptomatic
Usually diagnosed on routine blood test with fatigue
symptom
40 – 70 years usually around 50 years
Asymptomatic – abnormal high WBC count/ Platelets
Anaemia- Fatigue, malaise
Palpable splenomegaly – massive (50%) early satiety
and left upper quadrant pain or mass (from
splenomegaly)
Thrombotic or Vaso-occlusive events (from severe
leucocytosis or thrombocytosis) - priapism, MI,
venous thrombosis,visual disturbances, pulmonary
insufficiency, drowsiness,loss of coordination,
confusion,or CVA)
Bleeding diatheses findings include retinal
haemorrhages, gastrointestinalbleeding
Atypical –
Weight loss, night sweats (if high burden)
Markedthrombocytosis without leucocytosis
5% diagnosedin acceleratedor blast phase
High basophil count may produce histamine causingpruritis, flushing
Splenomegaly is the most common physical finding
Splenic enlargement in Chronic Phase is due to infiltration ofthe red pulp cords by
mature and immature granulocytes. A similar infiltrate can be seen in hepatic sinuses
and portal areas.
Other less common findings include hepatomegaly (5–10%),
lymphadenopathy (5–10%)
Accelerated or Blast phase
Unexplained fever, significant weight loss,infections,
bleeding & thrombotic events.
Extramedullary disease is usually seen
INVESTIGATIONS
Spleen size Palpation and by USS abdomen
Hb
CBC
Low
--
TLC DLC 10000 to 600000 /cumm
(Usually 25000-80000 /cumm)
unexplained and sustained leucocytosis
Platelets Thrombocytosis
PBS
(essential)
Hypercellular – myeloidhyperplasia
Bands, promyelocytes, Myelocytes,
segmentedneutrophils,
Blast < 5% (usually <2%)
Philadelphia chromosome present
Basophilia as the disease progresses
Significant granulocyte dysplasia absent
LAP Score Increased in leukemoid reaction (Normal cells)
Not required in AML(cells immature)
Decreasedin CML (Cell mature but not
normal)
Serum
Uric Acid
High (rapid cell turnover)
Serum LDH High (rapid cell turnover)
Blood or BM
(essential)
Quantitative RT-PCR (qPCR) using
international scaleorFISH for BCR-ABL1
Bone Marrow
Aspiration &
Biopsy
(Not
essential)
BM is hypercellular, marked myeloid
hyperplasiaand blast < 5% with no dysplasia
BMA is essential for complete karyotype
for morphological evaluation to confirm the
phase of disease
Chromosomal abnormalities –
Ph chromosome cytogenetics by karyotyping
FISH method if cytogenetics is not available
3. Confirmatory
test
CBC, Spleen size
Conventional karyotyping
Detect fusion BCR-ABL1
RT-PCR to detect BCR-ABL1
FISH when Ph -ve
BM Exam- for phase of disease
Biochem profile and viral markers
Advanced
CML
Flow Cytometry to determine cell lineage
Mutational analysis – by molecular test
HLA testing – for considering allogenic HCT
PET CT: Extramedullary disease in blast crisis
PERIPHERAL SMEAR IN CHRONIC PHASE
BCR ABL1
Qualitative RT PCR
(in PB & BM)
FISH
(In Selected cases)
Ph Chromosome Quicker then RTPCR
Also picks other BCR-ABL1
fusion patterns like m-bcr,
micro-bcr
BONE MARROW EXAM – Required to decide phase of disease but for
initial diagnosisit is not essential as Ph Chromosome can be testedin
peripheral blood.
MONITORING PATIENTS ON TKI THERAPY
03 monthly
Monitoring is by cytogenetics, FISH, and molecular
studies has become an important standardpractice to
assess response to therapy, emphasize compliance,
evaluate possible treatment resistance, identify the
need to change TKI therapy, and determine the need
to assess for kinase domain mutations.
ACCELERATED PHASE CML
> 15% peripheralblast cells
Increase in basophils
Thrombocytopenia
Cytogenetic clonal evolution
BLAST CRISIS CML
>30% peripheralor marrow blast
Sheets of blast in extramedullary disease
(Extramedullary disease occurs usually in blast crises)
DIFFERENTIAL DIAGNOSIS
1. LEUKEMOID REACTION
2. BCR-ABL1 NEGATIVE MPN
3. MDS-MPN
BLAST < 5% Myeloid bulge
Significant
Leukocytosis
4. TREATMENT
TYROSINE KINASE INHIBITORS
Estimated 10-year survival in CML is 85% with TKI therapy.
Imatinib All phases (first line)
Dasatinib All phases (second line) (potent)
Nilotinib All phases (second line) (potent)
(Except B Phase)
Bosutinib All phases (second line) (potent)
Ponatinib All phase – for mutant clones
Reduce dose later
Protein synthesis inhibitor with selective inhibition of
BCR-ABL1 oncogene
Omacetaxine After failure of > 2 TKI
Imatinib, nilotinib, and dasatinib are all acceptable frontline
therapies in CML. The long-term results of imatinib are very
favorable.
Salvage therapy in chronic phase with dasatinib, nilotinib,
bosutinib is associated with complete cytogenetic response
rates of 30–60%, depending on the salvage status
(cytogenetic vs hematologic relapse), prior response to other
TKIs, and the mutations at the time of relapse.
Ponatinib is the only TKI active in the setting of T315I
mutation, with complete cytogenetic response rates of 50–
70% among patients who have received 2 or more TKI.
AIM OF THERAPY
CML is now considered an indolent disease, which, with
appropriate continuous TKI therapy, treatment compliance,
careful monitoring, and early change to other TKIs as
indicated, can be associated with close to normal survival.
Therefore, in standard practice, achievement and
maintenance of a complete cytogenetic response are the
aims of therapy because complete cytogenetic response is the
only outcome associated with survival prolongation.
Molecular cures (off TKI therapy) are estimated to be about
15% post-imatinib therapy and 20–25% post–second-
generation TKIs by obtaining undetectable BCR-ABL1
transcripts for > 2 years.
INDICATOR OF FAILURE OF TKI
A general practice rule is to continue the particular TKI
chosen at the most tolerable dose schedule not associated with
grade 3–4 side effects or with bothersome chronic side
effects, for as long as possible,until either cytogenetic relapse
or the persistence of unacceptable side effects. These two
factors (i.e., cytogenetic relapse and intolerable side effects as
judged by the patient and treating physician)are the indicators
of “failure” of a particular TKI therapy
ALLOGENEIC STEM CELL
TRANSPLANT
Allogeneic SCT, a curative modality in CML, is associated
with long-term survival rates of 40–60% when implemented
in the chronic phase. It is associated with early (1-year)
mortality rates of 5–30%. Although the 5- to 10-year survival
rates were reported to be around 50–60% (and considered as
cure rates), about 10–15% of patients die in the subsequent
1–2 decades from subtle long-term complications of the
transplant (rather than from CML relapse). These are related
to chronic graft-versus-host disease (GVHD), organ
dysfunction.
The maturing positive experience with TKIs has now
relegated SCT use to after first-line TKI failures. Among
patients who present with or evolve to blastic phase,
combinations of chemotherapy and TKIs should be used to
induce remission, followed by allogeneic SCT as soon as
possible.
OTHER THERAPIES – used earlier
HYDROXYUREA
Hydroxyurearemainsasafe andeffectiveagent(at
dailydosesof 0.5–10 g) to reduce initial CMLburden,
as a temporarymeasure inbetweendefinitive
therapies,orincombination withTKIstosustain
complete hematologicorcytogeneticresponses.
INTERFERON α
Interferonα isconsideredincombinationwithTKIs
(an investigational approach),sometimesafterCML
failure onTKIs.
TREATMENT OF
ACCELERATED AND BLASTIC PHASES
Patients in accelerated or blastic phase may receive therapy
with TKIs, preferably second- or third-generation TKIs
(dasatinib, nilotinib, bosutinib, ponatinib), alone or in
combination with chemotherapy, to reduce the CML burden,
before undergoing allogeneic SCT.
SUPPORTIVE
Anaemia, Bleeding
Metabolic problem, Nutrition, Renal assessment
Manage hyperuricemia – IV hydration, Allopurinol
Identify and manage thrombotic and veno-occlusive disease
PROGNOSIS
In the current era of TKI therapy, the most important prognostic
indicator is response to treatment at the haematological, cytogenetic,
and molecular level. However, therisk scores based on clinical and
haematological findings (the Sokol score and EUTOS score are also
valid).
Overall, the completecytogenetic responserate tofirst-lineTKIis 70―90%,
with 5-year progression-free and overall survival rates of 80-95%.