Perspectives on the treatment of chronic phase and advanced phase CML and Philadelphia chromosome positive ALL(1).
Chronic myeloid leukaemia (CML) is a malignant disease of the bone marrow characterised by the presence of the Philadelphia (Ph) chromosome. About 20% of acute lymphoblastic leukaemia (ALL) patients also show this genetic abnormality. A new drug, imatinib (Glivec, Novartis Pharma AG, Basel, Switzerland, and formerly STI571) is having a profound effect on the treatment and management of all stages of CML and Philadelphia chromosome positive (Ph+) ALL. New treatment algorithms are being developed. Should imatinib replace or be combined with existing therapies? To address this question, we review the pros and cons of therapy with interferon-alpha (IFN-alpha), allogeneic transplantation, autologous transplantation, imatinib, and in the case of Ph+ ALL, chemotherapy and experimental approaches. Conservative and aggressive treatments will be discussed and new molecular methods of monitoring cytogenetic response and their significance will also be reviewed.
Schiffer
C A
CA
Division of Hematology/Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Harper Hospital, Detroit, MI 48201, USA.
Hehlmann
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R
Larson
R
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D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides; D015415:Biomarkers; D014408:Biomarkers, Tumor / Q000032:analysis; D001752:Blast Crisis / Q000628:therapy; D001856:Bone Marrow Examination; D016026:Bone Marrow Transplantation; D016044:Fusion Proteins, bcr-abl / Q000032:analysis / Q000037:antagonists & inhibitors; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000068877:Imatinib Mesylate; D017404:In Situ Hybridization, Fluorescence; D016898:Interferon-alpha / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000628:therapy; D015465:Leukemia, Myeloid, Accelerated Phase / Q000188:drug therapy* / Q000628:therapy; D015993:Life Tables; D009363:Neoplasm Proteins / Q000032:analysis / Q000037:antagonists & inhibitors; D010879:Piperazines / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011743:Pyrimidines / Q000627:therapeutic use; D012074:Remission Induction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016879:Salvage Therapy; D016019:Survival Analysis
D000970:Antineoplastic Agents; D001549:Benzamides; D015415:Biomarkers; D014408:Biomarkers, Tumor; D016898:Interferon-alpha; D009363:Neoplasm Proteins; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D016044:Fusion Proteins, bcr-abl