Onkológia 5/2008

CHRONIC MYELOID LEUKEMIA – NEW TRENDS IN THE TREATMENT

The management of patients with chronic myeloid leukemia in chronic phase has changed dramatically with the introduction of imatinib (Glivec). Whether allogeneic transplantation should be offered as front-line therapy for children with HLA-identical donors is still controversial, but for all new adult patients it is now standard practise to start treatment with imatinib 400 mg daily. Patients who fail to respond to imatinib or lose the response should be treated with a second generation tyrosine kinase inhibitor, such as dasatinib or nilotinib, unless they have a T315I kinase domain mutation, which would render their leukemic cells resistant to these agents. Allogeneic stem cell transplantation may be offered for patients with suitable donors after failure of treatment with tyrosine kinase inhibitors except progression to accelerated/ blastic phase or if the mutation T315I is proved, the stem cell transplantation should be performed earlier.

Keywords: chronic myeloid leukemia, cytogenetic analysis, thyrosine kinase inhibitors, allogeneic stem cell transplantation, imatinib failure.