Cancer Treatment Today » Chronic Myelogenous Leukemia

Atypical CML

M Levin, MD — Fri, 03 Jan 2014 20:38:28 +0000

Atypical chronic myelogenous leukemia (aCML) is a leukemic disorder that exhibits both myelodysplastic and myeloproliferative features at the time of diagnosis. What this means is that it is not truly a CML but a condition that can be confused with CML, but is essentially different. It is not very common. It is thought that these features denote a poor prognosis, but these cases ahve a variety of genetic abnormalities that are different from CML and not much is known about how theya ffect prognosis. Atypical CML cases are usually BCR-ABL negative. The optimal treatment of aCML is uncertain because of the rare incidence of this chronic leukemic disorder. Treatment with hydroxyurea may lead to short-lived partial remissions of 2- to 4-months’ duration. Atypical CML, appears to respond poorly to treatment with interferon-alpha or other CML treatments.

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Iclusig (ponatinib)

M Levin, MD — Thu, 28 Feb 2013 17:50:24 +0000

Ponatinib (Iclusig, AP24534) was recently FDA approved for the treatment of chronic myeloid leukemia (CML) and Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL). It was approved based on the inital results of The PACE (Ponatinb Ph+ ALL and CML Evaluation) trial. B ecasue it not only attacks the CML mutation, BCR-ABL (including the T315I that other drugs doen affect it is an attarctive candidate for personalized use in conditions that display these mutations in the Personalized Medicine approach.

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Personalized Medicine

Sprycel after failing Gleevec

M Levin, MD — Thu, 17 Jan 2013 17:01:41 +0000

On June 28, 2006, the U.S. Food and Drug Administration approved dasatinib (Sprycel; Bristol-Myers Squibb), a new small-molecule inhibitor of multiple tyrosine kinases, for the treatment of adults with chronic phase, accelerated phase, or myeloid or lymphoid blast phase chronic myeloid leukemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+) ALL) with resistance or intolerance to prior therapy including imatinib. The approval was based on four single-arm multicenter studies that combined 445 patietns and supported the efficacy and safety of dasatinib.

The FDA approval was for newly diagnosed patinets; however, there is evidence that Sprycel is effective in patients who fail imatinib as well. Study CALGB 180-034 was designed to assess the efficacy and safety of dasatinib following intolerance or resistance to imatinib. With six years fo followup, thirty-one percent of patients randomised to receive dasatinib 100 mg once daily remained on treatment. There was progression-free survival of 49.3% and an overall survival of 71% for with 6% of patients (n=10) progressing to accelerated or blast phase on study at six years of follow-up. Common toxicities with dasatinib included myelosuppression, bleeding, and fluid retention.

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