Accelerated Phase CML: Outcomes in Newly Diagnosed vs. Progression From Chronic Phase

Mukherjee, Sudipto; Kalaycio, Matt

doi:10.1007/s11899-016-0304-7

Cited by 21 publications

(10 citation statements)

References 51 publications

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“…80,81 The current NCCN guidelines 42 suggest allo-SCT for patients who progress to CML-BP and that it should be performed within a 3-to 6-month interval from diagnosis. 80,81,90,91 Although several previous studies have demonstrated that the use of TKI before transplantation does not seem to have a negative effect on the outcome of allo-SCT in CML, 92,93 a more recent study including adult patients receiving 1, 2, or 3 TKIs before allo-SCT clearly showed that the nonrelapse mortality rate was higher in patients with 3 TKIs than in patients treated with 1 or 2 TKIs. 94 Also in adults, it was demonstrated that patients with CML-BP harboring a T315I mutation had better outcomes with allo-SCT than with ponatinib.…”

Section: Casementioning

confidence: 99%

How I treat chronic myeloid leukemia in children and adolescents

Hijiya

Suttorp

2019

Blood

112

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Evidence-based recommendations have been established for treatment of chronic myeloid leukemia (CML) in adults treated with tyrosine kinase inhibitors (TKIs), but the rarity of this leukemia in children and adolescents makes it challenging to develop similar recommendations in pediatrics. In addition to imatinib, which was approved for pediatric CML in 2003, the second-generation TKIs dasatinib and nilotinib were recently approved for use in children, expanding the therapeutic options and pushing allogeneic stem cell transplantation to a third-line treatment of most pediatric cases. Yet, without sufficient data on efficacy and safety specific to pediatric patients, the selection of a TKI continues to rely on clinical experience in adults. Here, we present 4 case scenarios highlighting common yet challenging issues encountered in the treatment of pediatric CML (suboptimal response, poor treatment adherence, growth retardation, and presentation in advanced phases). Limited experience with very young children, the transition of teenagers to adult medicine, and the goal of achieving treatment-free remission for this rare leukemia are additional significant obstacles that require further clinical investigation through international collaboration.

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Section: Casementioning

confidence: 99%

How I treat chronic myeloid leukemia in children and adolescents

Hijiya

Suttorp

2019

Blood

112

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“…10 The annual fatality rate changed to 1%-2% after 2000 from 10% to 20%. 3 , 11 A previous study indicated that the estimated prevalence of CML is approximately 144,000 in 2030, 167,000 in 2040, and 181,000 in 2050, when it will reach a near plateau prevalence. 12 Under such a large CML patient population, how should global or regional health policy-makers allocate limited health resources is a major challenge.…”

Section: Introductionmentioning

confidence: 99%

Magnitude and Temporal Trend of the Chronic Myeloid Leukemia: On the Basis of the Global Burden of Disease Study 2019

Hou

et al. 2021

JCO Global Oncology

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PURPOSE To map the magnitudes and temporal trends of chronic myeloid leukemia (CML) along with its attributable risk factors, providing the essential foundation for targeted public policies at the national, regional, and global levels. MATERIALS AND METHODS We retrieved annual data on CML burden in 204 countries and regions from the Global Burden of Disease Study 2019 in 1990-2019. The estimated annual percentage change (EAPC) was calculated to quantify the temporal trends of CML burden by region, sex, and age group. RESULTS Globally, the age-standardized incidence rate of CML declined weakly over the past few years (EAPC: −1.04), but the number of incident cases increased by 54.1% to 65.8 × 103 in 2019. By contrast, a dramatic drop in death and disability-adjusted life years (DALYs) rate (EAPCs: −2.55; −2.69) led to a reduction in deaths and DALYs, especially in high-income regions. In 2019, the highest age-standardized death rate was observed in Ethiopia (1.89 per 100,000). The death rate of CML was pronounced among the population age above 70 years. DALYs of CML worldwide were primarily attributable to smoking (12.2%), high body mass index (5.0%), occupational exposure to benzene (0.9%), and occupational exposure to formaldehyde (0.3%) in 2019. CONCLUSION Although the mortality rate of CML has decreased significantly, the management of patients with CML cannot be neglected, especially in elders and developing regions.

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“…The stereotypical progression of CML is from a relatively benign chronic phase (CP) to accelerated phase (AP) to a fatal blast phase (BP) resembling acute leukemia, the prognosis for which is poor, with a median survival time of only 3~4 months [2]. Given that all treatments work much better in CP than advanced-phase disease, it is therefore important to explore the mechanism underlying stage progression of CML [3].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Number and Phenotype of Macrophages in the Human BMB Samples of CML

Song

Dian

Mei

et al. 2016

BioMed Research International

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Macrophages have emerged as a key player in tumor biology. However, their number and phenotype in human bone marrow of biopsy (BMB) samples of chronic myeloid leukemia (CML) and their association with disease progression from an initial chronic phase (CP) to accelerated phase (AP) to advanced blast phase (BP) are still unclear. BMB samples from 127 CML patients and 30 patients with iron-deficiency anemia (IDA) as control group were analyzed by immunohistochemistry. The expression levels of CD68, CD163, and CD206 in BMB samples of CML patients were significantly higher than those in the patients of control group (P < 0.01), and we observed that their positive expression was gradually elevated during the transformation of CML-CP to AP to BP (P < 0.01). However, the expressions of CD68, CD163, and CD206 in released group were downregulated and contrasted to these in control group; there exists statistical significance (P < 0.01). The percentage ratio of CD163 and CD206 to CD68 was pronounced to be increasing from CML-CP to AP to BP (P < 0.01). Hence, the higher proportion of CD68+, CD163+ and CD206+ macrophages in BMB samples can be considered a key factor for disease progression of CML patients. Targeting macrophages, especially the M2 phenotype may help in designing therapeutic strategies for CML.

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Accelerated Phase CML: Outcomes in Newly Diagnosed vs. Progression From Chronic Phase

Cited by 21 publications

References 51 publications

How I treat chronic myeloid leukemia in children and adolescents

How I treat chronic myeloid leukemia in children and adolescents

Magnitude and Temporal Trend of the Chronic Myeloid Leukemia: On the Basis of the Global Burden of Disease Study 2019

Assessment of the Number and Phenotype of Macrophages in the Human BMB Samples of CML

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