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Is Gleevec the right drug for treating chronic myeloid leukemia?

Q: My 31 years old wife was diagnosed with chronic myeloid leukemia (CML-CP) last year. She has been taking Gleevec 300mg since then. Now she is in complete cytogenetic response (CCR). Is her condition still life threatening?

A:CML is treated with Gleevec (imatinib) worldwide and this forms the first line therapy. The remarkable progress made in the treatment of chronic myeloid leukemia (CML) over the past decade has been accompanied by steady improvements in our capacity to accurately and sensitively monitor response to therapy. After the initial target of therapy, complete cytogenetic response (CCR), is achieved, peripheral blood BCR-ABL transcript levels measured by real-time quantitative reverse transcriptase PCR (RQ-PCR) define the subsequent response targets, major and complete molecular response (MMR and CMR).

At no point are we saying that imatinib therapy is going to cure the disease. Patients are treated with imatinib to achieve what I call “control” of the disease. The majority of patients on first-line imatinib therapy achieve a "safe haven" defined as a confirmed MMR, but 20% to 30% stop imatinib due to intolerance and/or resistance. Many imatinib-resistant patients can be effectively treated with second generation tyrosine kinase inhibitors (TKIs), but the actual drug selected should be based on the resistance profile of each inhibitor, in addition to issues of tolerance and disease phase. However, one needs to remember that in a case of young patients with CML allogenic stem cell transplantation would be a better choice and would be curative. This is so, provided one has the availability of a HLA matched donor. In your wife’s case, she being 31 years of age, the possibility of allogenic stem cell transplantation should be explored. Hope this is helpful.

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