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Blood, 1 October 2001, Vol. 98, No. 7, pp. 2039-2042
PERSPECTIVE
Chronic myeloid leukemia: current treatment options
John M. Goldman and
Brian
J. Druker
From the Imperial College School of Medicine, London,
United Kingdom, and the Oregon Health Sciences University, Portland.
The choice of primary treatment for patients with chronic myeloid
leukemia (CML) diagnosed in chronic phase has become exceedingly difficult. There is little doubt that allogeneic stem cell
transplantation can eradicate the leukemia and that a
graft-versus-leukemia effect makes a major contribution to this result;
conversely, only a minority of patients are eligible for
transplantation, which still carries an appreciable risk for death or
protracted illness. For most patients, interferon- (IFN-)
prolongs life to some degree in comparison with hydroxyurea, but it is
associated with considerable toxicity. The newly introduced tyrosine
kinase inhibitor STI571 induces complete hematologic remission in
almost all patients and is associated with a very high rate of
cytogenetic response; its capacity to prolong life in comparison with
IFN- is not yet established. Here are reviewed some factors that
predict survival after nontransplantation therapy and after
allografting for CML in chronic phase. Two contrasting options are
considered for managing the patient with newly diagnosed disease, and
it can be concluded that, for now, allogeneic stem cell transplantation
soon after diagnosis should continue to be offered as an option for
selected patients. Further experience with the use of STI571 as a
single agent or in combination with other antileukemic agents may alter the picture in the near future.
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Treatment options in chronic myelogenous leukemia
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Blood 2002 99: 3070-3071.
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