Current use of imatinib in the treatment of 3.57.51 PM

Current use of imatinib in the treatment of 3.57.51 PM -...

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Current use of imatinib in the treatment of chronic myeloid leukaemia Michael O’Dwyer Haematologica March 2003
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Within the past 12-18 months increasing  data have emerged regarding the role of  imatinib in treatment of chronic myeloid  leukemia (CML).
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However, despite impressive results in  chronic phase CML, several major questions  remain, including the durability of responses,  whether cytogenetic and molecular responses are  good surrogates for survival  and whether we can do better than imatinib 400  mg as a single agent .
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In parallel, results from stem cell  transplantation (SCT) continue to  improve, rendering decision-making  even more difficult for younger early  chronic phase patients for whom this  strategy could be an option.
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Preliminary results of the IRIS  study  This large randomized study compared  imatinib with interferon and ara-C in  newly diagnosed patients.  For all parameters assessed, imatinib  was clearly  superior  establishing it as  the new non-transplant therapy of  choice. 
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At 18 months with imatinib    major response  rates were 85%   complete cytogenetic  response rates were  74% In  contrast , less than 25% of interferon- treated patients achieved a major  cytogenetic response.
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However, despite these encouraging  response rates it is worth noting that  only a small  minority of patients (3%)  achieved molecular negativity  as  assessed by quantitative reverse  transcriptase polymerase chain reaction  (RT-PCR).
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Questions to be asked Can we do better than imatinib  400mg daily  as a single agent?  Should we be using  higher doses  and should  we add  other agents  to improve efficacy?  Such modifications could further improve the  rate and durability of complete cytogenetic  responses by avoiding  in vivo  selection of  resistant CML clones. 
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Current use of imatinib in the treatment of 3.57.51 PM -...

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