Treatment of chronic myeloid leukemia in era of imatinib

Authors: K. Indrák;  E. Faber;  M. Jarošová
Authors‘ workplace: Hemato-onkologická klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Karel Indrák, DrSc.
Published in: Vnitř Lék 2009; 55(Suppl 1)(Supplementum 1): 65-73


Authors introduce their review with description of historic achievements that enabled to reach the actual stage of knowledge on ethiopathogenesis of chronic myeloid leukemia (CML), to synthetize first tyrosine kinase inhibitor – imatinib (Glivec, IM) and to develop the revolutionary targeted treatment of CML. Targeted therapy has both completely changed prognosis of patients with CML and stimulated further discoveries in ethiopathogenesis of other malignancies that was followed also by introduction of specific targeted treatment. Authors explain basic terms of cytogenetic and molecular evaluation of treatment results, determination of optimal therapeutic response and failure during targeted treatment of CML. They provide overview of imatinib failure management, experience with second generation tyrosine kinase inhibitors and review the actual role of allogeneic hematopoietic stem cell transplantation in CML. According to the recent recommendations for CML treatment issued by National Comprehensive Cancer Network (NCCN 1/2009) regular monitoring using highly sofisticated laboratory methods every 3 months is necessary. In case of failure monitoring should be even more frequent and possibility of participation in international trials may play an important role. Finaly, pitfalls of targeted treatment mainly treatment failure, intolerance and leukemic stem cell resistance to tyrosine kinase inhibitors are discussed. Continual research of mechanisms of resistance, development of new and reintroduction of „older“ drugs like interferon alpha provide substantial hope for the future CML management.

Key words:
chronic myeloid leukemia– Philadelphia chromosom– tyrosine kinase inhibitor– imatinib– dasatinib– nilotinib– cytogenetic response– molecular response– allogeneic hematopoietic stem cell transplantation


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