Factors affecting duration of survival after onset of blastic transformation of chronic myeloid leukemia

Prognostic factors for patients with chronic myeloid leukaemia in chronic phase treated with imatinib mesylate after failure of interferon alfa

“…Invariably, the disease progresses eventually to a more advanced phase which is usually subclassified as either accelerated phase or blastic transformation; the latter phase is especially resistant to therapy and leads to death within 6-8 months. 2 Allogeneic stem cell transplant is the only therapy that can cure CML, but age and lack of a suitable donor limit this procedure to a minority of patients. 3 Interferon-a (IFNa) has until recently been the gold standard for treating patients who are not candidates for transplant.…”

Imatinib mesylate (STI-571) given concurrently with nonmyeloablative stem cell transplantation did not compromise engraftment and resulted in cytogenetic remission in a patient with chronic myeloid leukemia in blast crisis

“…3,5 Nevertheless, allogeneic HSCT should be considered if there is a suitable donor, as there is a small but significant curative potential. 9 Imatinib mesylate has been shown in two phase II trials to have substantial clinical activity with a favorable safety profile when used as a single agent in patients with CML in BC.…”

“…1 Once the disease progresses into BC, there is no proven standard therapy and the prognosis for these patients is poor. 2,3 Multiagent chemotherapy induces responses in only about 20% of patients with myeloblastic transformation and 50% of those with lymphoblastic transformation. 2,4 The median survival is 2-6 months and 9-12 months for nonlymphoid and lymphoid blastic phases respectively.…”

“…2,4 Allogeneic hematopoietic stem cell transplantation (HSCT) with myeloablative conditioning may be attempted, but this modality is associated with very poor survival as a result of high rates of both post-transplant relapse and nonrelapse mortality. 3,5 Imatinib mesylate (STI 571; Glivec; Gleevec) monotherapy for CML in BC is valuable in the short term, but does not appear to have any influence on the long-term clinical outcome. 3,6,7 Since the outcome of HSCT may be better in patients with BC transplanted in second chronic phase, 8 the activity of imatinib mesylate in patients with BC suggests that it may be a useful bridge to transplantation.…”

“…3,5 Imatinib mesylate (STI 571; Glivec; Gleevec) monotherapy for CML in BC is valuable in the short term, but does not appear to have any influence on the long-term clinical outcome. 3,6,7 Since the outcome of HSCT may be better in patients with BC transplanted in second chronic phase, 8 the activity of imatinib mesylate in patients with BC suggests that it may be a useful bridge to transplantation. The use of a nonmyeloablative regimen may afford advantages by avoiding undesirable transplant-related toxicities and, potentially, nonrelapse mortality.…”