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5 - Therapeutic decision making in BMT/SCT for chronic myeloid leukemia and other myeloproliferative syndromes

Published online by Cambridge University Press:  05 August 2013

By
Reinhold Munker ,
Hillard M. Lazarus  and
Kerry Atkinson
Edited by
Reinhold Munker ,
Gerhard C. Hildebrandt ,
Hillard M. Lazarus  and
Kerry Atkinson
Reinhold Munker
Affiliation:
Louisiana State University, Shreveport
Gerhard C. Hildebrandt
Affiliation:
University of Utah
Hillard M. Lazarus
Affiliation:
Ireland Cancer Center, Case Western Reserve University Hospital, Cleveland
Kerry Atkinson
Affiliation:
University of Queensland
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Summary

Classification of chronic myeloid leukemia (CML)

Clinical variants of CML:

  1. Typical CML (Philadelphia chromosome present, BCR/ABL-positive [94%])

  2. Atypical CML (Philadelphia chromosome absent, BCR/ABL-positive [4%])

  3. Atypical BCR/ABL negative CML (Philadelphia chromosome absent, BCR/ABL-negative [2%])

Staging of CML

Chronic phase:

  1. No significant symptoms

  2. None of the features of accelerated phase or blastic phase

  3. Sensitive to tyrosine kinase inhibitors (TKIs) (most newly diagnosed cases, see page 64)

  4. Resistant to TKIs

Accelerated phase (any one or more of the following criteria):

  1. WBC count difficult to control with conventional use of TKI or busulfan/hydroxyurea in terms of doses required

  2. Rapid doubling of WBC count (≥5 days)

  3. ≥10% blasts in blood or marrow

  4. ≥20% blasts plus promyelocytes in blood or marrow

  5. ≥20% basophils plus eosinophils in blood

  6. Anemia or thrombocytopenia unresponsive to TKI

  7. Persistent thrombocytosis

  8. Additional chromosome changes (evolving new clone)

  9. Increasing splenomegaly

  10. Development of chloromas or myelofibrosis

  11. Patient in a second (or subsequent) chronic phase after blast crisis

Type
Chapter
Information
The BMT Data Book
Including Cellular Therapy
 , pp. 56 - 66
Publisher: Cambridge University Press
Print publication year: 2013

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References

Andolina, JR, Neudorf, SM, & Corey, SJ. 2012. How I treat: childhood CML. Blood 119: 1821–1830.CrossRefGoogle Scholar
Baccarani, M, Cortes, J, Pane, F, et al. 2009. Chronic myeloid leukemia: an update of concepts and management recommendations of European Leukemia Net. J Clin Oncol 27: 6041–6051.CrossRefGoogle Scholar
CML Autograft Trials Collaboration. 2006. Autologous stem cell transplantation in chronic myeloid leukaemia: a meta-analysis of six randomized trials. Cancer Treat Rev 33: 39–47.Google Scholar
Crawley, C, Szydlo, R, Lalancette, M, et al. 2005. Outcomes of reduced intensity transplantation for chronic myeloid leukemia: an analysis of prognostic factors from the Chronic Leukemia Working Party of the EBMT. Blood 106: 2969–2976.CrossRefGoogle ScholarPubMed
Deeg, HJ & Appelbaum, FR. 2011. Indications for and current results with allogeneic hematopoietic cell transplantation in patients with myelofibrosis. Blood 117: 7185.CrossRefGoogle ScholarPubMed
Druker, BJ, Guilhot, F, O’Brien, SG, et al. 2006. Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med 355: 2408–2417.CrossRefGoogle ScholarPubMed
Guglielmi, C, Arcese, W, Dazzi, F, et al. 2002. Donor lymphocyte infusion for relapsed chronic myelogenous leukemia. Blood 100: 397–405.CrossRefGoogle ScholarPubMed
Jabbour, E, Cortes, J, Santos, FPS, et al. 2011. Results of allogeneic hematopoietic stem cell transplantation for chronic myelogenous leukemia patients who failed TKIs after developing BCR-ABL1 kinase domain mutations. Blood 117: 3641–3647.CrossRefGoogle ScholarPubMed
Kaeda, J, O’Shea, RM, Olavarria, E, et al. 2006. Serial measurement of BCR-ABL transcripts in the peripheral blood after allogeneic stem cell transplantation for CML: an attempt to define patients who may not require further therapy. Blood 107: 4171–4176.CrossRefGoogle Scholar
Papageorgiou, SG, Castleton, A, Bloor, A, et al. 2006. Allogeneic stem cell transplantation as treatment for myelofibrosis. Bone Marrow Transplant 38: 721–727.CrossRefGoogle ScholarPubMed
Scott, BL, Gooley, TA, Sorror, ML, et al. 2012. The dynamic international prognostic scoring system for myelofibrosis predicts outcomes after hematopoietic cell transplantation. Blood 119: 2657–2664.CrossRefGoogle ScholarPubMed

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