Therapeutic strategy for chronic myeloid leukemia: possibilities and prospects

• Main Authors: A G Turkina, E Iu Chelysheva
• Format: Article
• Language: Russian
• Published: "Consilium Medicum" Publishing house 2013-07-01
• Series: Терапевтический архив
• Subjects: chronic myeloid leukemia; tyrosine kinase inhibitors; minimal residual disease; bcr-abl tyrosine kinase; therapy discontinuation; register
• Online Access: https://ter-arkhiv.ru/0040-3660/article/view/31271
• ISSN: 0040-3660; 2309-5342

Over the past decade the clinical introduction of agents that directionally blocks the activity of BCR-ABL tumor tyrosine kinase (TK) has changed the prognosis of chronic myeloid leukemia. A significant malignant Ph'-positive clone inhibition and durable remissions have made it possible to increase overall and relapse-free survival. Due to their higher life expectancy, the number of patients is on the increase and their quality of life and working capacity remain good. According to the All-Russian Register of Chronic Myeloid Leukemia, there were more than 6500 cases in the Russian Federation in 2012. Of them, 93.1% were diagnosed with the chronic phase of the disease, 6.4 and 0.4% with its accelerated phase and blast crisis, respectively. Among the BCR-ABL TK inhibitors (TKI) registered in the Russian Federation and recommended for the treatment of chronic myeloid leukemia, there are 3 medications: imatinib, nilotinib, and dasatinib. The efficiency and safety of TKI therapy have been well studied. The most important principle of treatment is to permanently affect the Ph'-positive tumor cell clone by the long-term daily use of TKIs. Regular cytogenetic and molecular genetic monitoring allows adequate estimation of the leukemic clone volume and it is essential in evaluating the therapeutic effectiveness. To choose a TKI for each specific patient with regard for its best tolerability and maximum efficiency permits individualized treatment. The prospect of therapy discontinuation can be discussed only in individual patients with a durable and stable complete molecular response and only within clinical trials.