How I treat obesity and obesity related surgery in patients with chronic myeloid leukemia: An outcome of an ELN project

Abstract

Obesity is a chronic disease that is increasing in prevalence in adults, adolescents, and children and it is now considered to be a global epidemic. Current recommendation for treatment of Chronic Myeloid Leukemia (CML) does not take in consideration the weight of the patient with regard to doses of different Tyrosine Kinase Inhibitors. Obesity and obesity related surgeries are emerging and unmet needs. To shed the light into this special category of patients and we provide a strategy to treat morbid obesity with CML as well as obesity related surgeries like gastric band, sleeve gastrectomy in patients with CML. Five case scenarios were used to illustrate what is seen in real life: CML (CP) with class III obesity, CML (CP) with sleeve Gastrectomy, CML (CP) post gastric band CML with blast crisis each scenario were followed by proposal for treatment. Obesity and obesity related surgeries are emerging and unmet needs, the treatment of each should be individualized, and the TKI dose may needs to be adjusted in certain categories. The morbidity and mortality associated with being overweight (body mass index [BMI] of 25-29.9 kg/m 2) or obese (BMI of ≥ 30 kg/m 2) have been known to the medical profession for more than 2000 years. Obesity is a chronic disease that is increasing in prevalence in adults, adolescents, and children and it is now considered to be a global epidemic. 1 Body mass index (BMI) based classifications were originally based upon the associated risks of cardiovascular disease (CVD). The recommended classifications for BMI, adopted by the National Institutes of Health (NIH) and World Health Organization (WHO), 2,3 for Caucasian, Hispanic, and black individuals are: Underweight-<18.5 kg/m 2 Normal weight-≥18.5 to 24.9 kg/m 2 Overweight-≥25.0 to 29.9 kg/m 2 Obesity-≥30 kg/m 2 Class I-30.0-34.9 kg/m 2 Class II-35.0-39.9 kg/m 2 Class III-≥40 kg/m 2 (also referred to as severe, extreme, or massive obesity)

Severe obesity in a patient on long-term treatment of chronic myeloid leukemia with imatinib: Body composition, associated disorders and outcome

“…Interestingly, one case report described a woman with a BMI of 50 and a weight of 122 kg with obstructive sleep apnea syndrome and gastroesopha-geal reflux who needed a higher dose of imatinib (800 mg/d) to obtain a complete cytogenetic response and was treated later with bariatric surgery [12]. Another report of mantained major molecular response with a dose of 800 mg/d has been described, but the patient was an extreme case of a woman with a BMI of 113 and a weight of 275 kg, different from other case in the same report of a man with a BMI of 51 and a weight of 166 kg who obtained the molecular target with an imatinib dose of 400 mg/d [13]. One further woman with a previous bariatric surgery for weight loss achieved a complete response with 400 mg/d of imatinib, but the authors did not explain if severe obesity was still present [14].…”

Anxieties, age and motivation influence physical activity in patients with myeloproliferative neoplasms - a multicenter survey from the East German study group for hematology and oncology (OSHO #97)

“…atherosclerosis themselves. Furthermore, obesity might influence pharmacokinetics of drugs used in MPN treatment, although data is limited ( 30 – 33 ).…”

Patient with clinical celiac disease mimicking triple‐negative essential thrombocythemia

“…Our group is studying the unmet needs and unanswered questions in Philadelphia negative MPNs such as priapism 22 as well as unmet needs in CML such as the effects of intermittent fasting 23 and obesity 24 in response to TKIs as well as priapism. 25 …”

“…She was not on a gluten-free diet before the diagnosis. 21 Our group is studying the unmet needs and unanswered questions in Philadelphia negative MPNs such as priapism 22 as well as unmet needs in CML such as the effects of intermittent fasting 23 and obesity 24 in response to TKIs as well as priapism. 25 In conclusion, patients with suspected essential thrombocythemia (ET) who are triple-negative should be screened for celiac disease before doing more sophisticated studies such as gene sequencing or more invasive tests such as bone biopsy.…”