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Monitoring Therapy in Chronic Myeloid Leukemia Treatment Options for CML Overcoming Treatment Resistant CML

Cancer

Understanding CML Therapy: Responses and Side Effects

Summary & Participants

One of the greatest success stories in cancer treatment occurs in people with chronic myeloid leukemia. But treatments don't always work well in everyone. Learn what can happen.

Medically Reviewed On: June 26, 2006

Webcast Transcript

ANNOUNCER: Most of the 5,000 people who are diagnosed with chronic myeloid leukemia each year can look forward to long and good lives.

BRIAN DRUKER, MD: One of the interesting evolution in my own thinking about CML is that we've turned this into a chronic disease, much like treating a diabetic with insulin. If we're doing that and allowing patients to live very, very long and hopefully otherwise healthy lives, we really need to focus our effort on finding well-tolerated treatments so that living with the disease doesn't become too much of a burden.

ANNOUNCER: Success in treating the disease means the ability to block the out-of-control reproduction of white blood cells in the bone marrow: the hallmark of CML.

BRIAN DRUKER, MD: Just to give you an example, the normal white blood count should be 5,000 to 10,000. A CML patient diagnosis is with a white blood count of 50,000 to 500,000. So five to 50 times the upper limit of normal.

ANNOUNCER: A relatively new drug, called Gleevec, is usually very effective in returning the white counts to normal, and in combating the underlying disease.

MOSHE TALPAZ, MD: Gleevec, or its scientific name is imatinib mesylate, is a highly effective drug in CML. In newly diagnosed patients, it works virtually in every patient. About 95 percent of newly diagnosed patient achieve what we call hematologic remission, which means the counts normalize.

The most significant cytogenetic remission, which means the changes in the bone marrow towards restoration of normal bone marrow, happens in about 80 percent of the patient.

ANNOUNCER: And Gleevec generally has only mild side effects, another important treatment goal, especially with a drug that may be used for many years.

STEPHEN O'BRIEN, MBChB, PhD: You can occasionally feel a bit nauseous, some have some diarrhea, patients frequently retain fluid, so they sometimes get bags around their eyes a little bit, gain weight a little bit. But for the majority of patients, it really is very well-tolerated, by and large.

ANNOUNCER: Serious side effects occur much less frequently.

BRIAN DRUKER, MD: The percent of patients that have to stop Gleevec because of serious side effects is running about 3 to 5 percent with now close to five years of follow-up. The most common reasons for discontinuing include skin rashes and liver enzyme abnormalities.

ANNOUNCER: Serious drops in blood counts can occur, too.

STEPHEN O'BRIEN, MBChB, PHD: In a small proportion of patients, it's about 10 or 15 percent of newly diagnosed patients, their white blood cell count can go to a level which could be dangerous to them, in terms of risk of infection. And, also, the blood platelet count could go very low, which represents a risk in terms of bleeding.

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