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Monitoring Therapy in Chronic Myeloid Leukemia Understanding CML Therapy: Responses and Side Effects Overcoming Treatment Resistant CML

Leukemia Leukemia Treatment

Treatment Options for CML

Summary & Participants

A majority of people with CML do well with treatments. But a few will develop serious side effects or develop drug resistance. Listen to experts as they describe what can be done.

Medically Reviewed On: June 26, 2006

Webcast Transcript

ANNOUNCER: The treatment of chronic myeloid leukemia, characterized by a genetic defect known as the Philadelphia chromosome, changed dramatically with the discovery of a targeted cancer drug.

BRIAN DRUKER, MD: The current standard treatment for a patient with CML would be Gleevec or imatinib. This is a targeted therapy and in over 97 percent of patients you can return the blood counts to normal and in 80 percent of patients we see a disappearance of the Philadelphia chromosome.

ANNOUNCER: But sometimes there's a sub-optimal response. One problem can be side effects. The mild ones, fluid retention, nausea, vomiting, and muscle cramps, can usually be tolerated, or managed with other treatment.

Other side effects can be more serious. These include liver problems, rashes, and low blood counts. For some patients, a reduction in dose, from a standard 400 milligrams, can help. But it may also reduce the effectiveness of the drug.

One technique to manage serious side effects is a temporary interruption in the use of Gleevec, a technique called a dose holiday.

BRIAN DRUKER, MD: For patients who can't tolerate Gleevec because of skin rashes, actually one of the things we do is we'll stop Gleevec and try to restart them while treating them with some steroids. In about half of our patients we've been able to restart without a recurrence of a severe skin rash.

ANNOUNCER: Another sub optimal response with Gleevec is relapse due to resistance.

STEPHEN O'BRIEN, MD, PhD: It extends across the spectrum of the disease. So, for example, if you look at blast crisis patients at the extreme end of the spectrum of CML, then the majority of those patients, 80 or 90 percent eventually will develop resistance to the drug. If you look at early chronic phase patients, those who've just been diagnosed, current studies would suggest it's only about 4 percent of those patients who develop resistance. So it very much depends on the phase of the disease when treatment is started.

ANNOUNCER: Higher doses of Gleevec are often the first step when resistance is encountered. But higher doses may increase side effects, or their severity.

STEPHEN O'BRIEN, MD, PhD: The reduction in the blood counts to a particularly low level certainly seems to be dose-related. For example, on the standard dose of 400 milligrams, the incidence of those low blood counts is around about 10 or 15 percent. On the higher doses of drug, for example, 800 milligrams, the incidence of low white cells is of the order of 25 or 30 percent, so it clearly does seem to be dose-related.

ANNOUNCER: A patient who experiences resistance on Gleevec might consider a bone marrow transplant, if a medically appropriate donor can be found. Traditionally, this risky procedure was an option for relatively young patients. New techniques, however, are making transplants more broadly available.

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