Do we need more drugs for chronic myeloid leukemia?
Identifieur interne : 000230 ( Istex/Curation ); précédent : 000229; suivant : 000231Do we need more drugs for chronic myeloid leukemia?
Auteurs : Tessa L. Holyoake [Royaume-Uni] ; G. Vignir Helgason [Royaume-Uni]Source :
- Immunological Reviews [ 0105-2896 ] ; 2015-01.
Abstract
The introduction of protein tyrosine kinase inhibitors (TKIs) in 1998 transformed the management of chronic myeloid leukemia (CML), leading to significantly reduced mortality and improved 5 year survival rates. However, the CML community is faced with several clinical issues that need to be addressed. Ten to 15% of CML patients are diagnosed in advanced phase, and small numbers of chronic phase (CP) cases experience disease progression each year during treatment. For these patients, TKIs induce only transient responses and alternative treatment strategies are urgently required. Depending on choice of first line TKI, approximately 30% of CML CP cases show suboptimal responses, due to a combination of poor compliance, drug intolerance, and drug resistance, with approximately 50% of TKI‐resistance caused by kinase domain mutations and the remainder due to unknown mechanisms. Finally, the chance of successful treatment discontinuation is on the order of only 10–20% related to disease persistence. Disease persistence is a poorly understood phenomenon; all CML patients have functional Philadelphia positive (Ph+) stem and progenitor cells in their bone marrows and continue to express BCR‐ABL1 by DNA PCR, even when in very deep remission and following treatment discontinuation. What controls the maintenance of these persisting cells, whether it is necessary to fully eradicate the malignant clone to achieve cure, and how that might be approached therapeutically are open questions.
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DOI: 10.1111/imr.12234
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Holyoake</name><affiliation wicri:level="1"><mods:affiliation>Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow</wicri:regionArea></affiliation><affiliation><mods:affiliation>Correspondence to:Paul O'Gorman Leukaemia Research CentreInstitute of Cancer SciencesCollege of Medical, Veterinary & Life SciencesUniversity of GlasgowGlasgow G11 0YN, UKTel.: +44 0141 301 7880Fax: +44 0141 301 7898e‐mail:</mods:affiliation><wicri:noCountry code="subField">7898e‐mail:</wicri:noCountry></affiliation><affiliation wicri:level="1"><mods:affiliation>E-mail: tessa.holyoake@glasgow.ac.uk</mods:affiliation><country wicri:rule="url">Royaume-Uni</country></affiliation></author><author><name sortKey="Helgason, G Vignir" sort="Helgason, G Vignir" uniqKey="Helgason G" first="G. 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However, the CML community is faced with several clinical issues that need to be addressed. Ten to 15% of CML patients are diagnosed in advanced phase, and small numbers of chronic phase (CP) cases experience disease progression each year during treatment. For these patients, TKIs induce only transient responses and alternative treatment strategies are urgently required. Depending on choice of first line TKI, approximately 30% of CML CP cases show suboptimal responses, due to a combination of poor compliance, drug intolerance, and drug resistance, with approximately 50% of TKI‐resistance caused by kinase domain mutations and the remainder due to unknown mechanisms. Finally, the chance of successful treatment discontinuation is on the order of only 10–20% related to disease persistence. Disease persistence is a poorly understood phenomenon; all CML patients have functional Philadelphia positive (Ph+) stem and progenitor cells in their bone marrows and continue to express BCR‐ABL1 by DNA PCR, even when in very deep remission and following treatment discontinuation. What controls the maintenance of these persisting cells, whether it is necessary to fully eradicate the malignant clone to achieve cure, and how that might be approached therapeutically are open questions.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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