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.[1]
Medical Therapy
Medical therapy depends on the phase of chronic myelogenous leukemia.
Chronic Phase
- Targeted therapy[2]
- Targeted therapy is the primary treatment for most people with CML in the chronic phase. The types of targeted therapy used are:
-
- Standard first-line therapy
-
- 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
-
- 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[2]
- 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[2]
- 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:
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
- ↑ National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/types/leukemia/hp/cml-treatment-pdq#section/_19
- ↑ 2.0 2.1 2.2 Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/treatment/chronic/?region=ab