Chronic Myelogenous Leukemia

Atypical CML – pro

Atypical chronic myelogenous leukemia (aCML) is a leukemic disorder that exhibits both myelodysplastic and myeloproliferative features at the time of diagnosis. It is thought that these features dennote a poor 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

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Iclusig – pro

Ponatinib (Iclusig, AP24534) was 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  and has activity against the T315I mutation, which confers resistant to other CML drugs. It targets the Bcr-Abl tyrosine kinase, as well as VEGFR, PDGFR, FGFR, the SRC kinases,

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Sprycel second line after Gleevec- pro

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

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Neupogen for Gleevec induced neutropenia – pro

Many chemotherapeutic drugs cause neutropenia and guidelines now uniformly recommend G-CSF(granulocyte growth stimulating factors) prophylactically and therapeutically for chemotherapy. However, non-chemo drugs can also cause neutropenia. Among them are bcr-abl directed drugs used for CML, such as Gleevec. Depending on the stage, up to 70% of the patients treated with imatinib for CML experience an NCI grade 3 or 4 neutropenia or thrombocytopenia

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BCR/ABL Monitoring of chronic myelogenous leukemia on Gleevec – pro

There have been no studies that demonstrate that followup with BCR/ABL assists with actual clinical management of CML but it has become standard based on a guideline recommendation.It is not clear what the best monitoring stategy of imatinib might be; however, bcr/abl analysis would be a part of any finally accepted strategy. Unfortunately no trials of such strategies have been eprfomred but there is guidance from expert consensus. Some physicians

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Stem cell transplantation for CML – pro

Despite improvement of treatment with Gleevec, Sprycel and Tasigna, allogeneic stem cell transplantation remains the only curative treatment for patients with CML. This form of treatment is only available for a small minority of patients due to the advanced age of most patients at the time of diagnosis and the lack of a suitable related or unrelated allogeneic stem cell donor. Despite significant progress, allogeneic transplants are associated with

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JAK2 for diagnosis – pro

Lay Summary: JAK2 testing can now be performed for a diagnosis of a myeloproliferative disorder.  This is now an acceptable approach to diagnosing myeloproliferative disorders. In early 2005, several groups of investigators reported a somatic acquired point mutation in the JAK2 (Janus kinase 2) protein in the blood and bone marrow of patients with BCR/ABL-negative chronic myeloproliferative disorders. JAK2 is a tyrosine kinase which plays an important

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Gleevec for bcr/abl negative chronic myelogenous leukemia – pro

The diagnosis of chronic myelogenous leukemia (CML) consists of a complete blood count with differential, peripheral blood smear, and bone marrow analysis. Although typical hepatomegaly and splenomegaly may be imaged by using a liver/spleen scan, these abnormalities are often so obvious clinically that radiologic imaging is not necessary. The biologic basis of the disease is the bcr/abl compund gene and diagnosis of CML is based on the histopathologic

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Interferon for Myeloproliferative disorders – pro

The myeloproliferative disorders consist of polycythemia vera, chronic myelogenous leukemia, agnogenic myeloid metaplasia, and essential thrombocythemia. All these disorders are thought to result from a hematopoietic stem cell lesion. Interferon alfa is effective in suppressing bone marrow function in chronic myeloproliferative disorders, but this treatment requires multiple weekly injections. Pegylated interferon, on the other hand, can be given

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Umbilical cord stem cells – pro

Lay summary: Cord stem cells have been shown to be equivalent to other allogeneic cells for transplantation in leukemia but not yet for other diagnoses. Cord blood transplantation is a fairly recent but rapidly becoming established technique for transplnatation in leukemia. The first unrelated cord blood transplantations were performed in children. The first 25 unrelated cord blood transplantations were reported in 1996. Since then a number of reports

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