Treatment of Chronic Myeloid Leukaemia
Treatment of chronic myeloid leukaemia has been revolutionised by the development of targeted therapies. While chronic myeloid leukaemia was once considered a fatal illness, it is now often managed as a chronic condition. Many patients achieve deep molecular remission and maintain normal life expectancy with ongoing treatment.
1. Tyrosine Kinase Inhibitors (TKIs)
TKIs are the first-line treatment for most patients with CML. These drugs specifically block the BCR-ABL1 protein created by the Philadelphia chromosome, halting cancer cell growth.
Common TKIs include:
- Imatinib (Glivec) – the first TKI introduced, highly effective in the chronic phase
- Dasatinib and Nilotinib – second-generation TKIs used when resistance or intolerance to imatinib occurs
- Bosutinib and Ponatinib – used for more resistant cases or specific mutations
TKIs are usually taken orally once or twice daily and require lifelong adherence.
2. Monitoring Treatment Response
Regular PCR tests are used to monitor the level of BCR-ABL1 in the blood. A major molecular response within 12 months is a positive sign. Treatment is adjusted if milestones are not met or if side effects are intolerable.
3. Stem Cell Transplant | Treatment of Chronic Myeloid Leukaemia
For patients in blast crisis or with resistance to multiple TKIs, allogeneic stem cell transplantation may be considered. This option is high-risk and generally reserved for younger patients or those with aggressive disease.
4. Supportive Care
Management of side effects such as fatigue, anaemia, or infections is essential. Some patients experience fluid retention, muscle cramps, or gastrointestinal issues. Regular monitoring helps manage these side effects and ensures continued treatment adherence.
5. Treatment-Free Remission (TFR) | Treatment of Chronic Myeloid Leukaemia
Some patients who achieve deep, sustained remission may be eligible to stop therapy under medical supervision. This approach is still being studied but offers hope for long-term drug-free remission.
In summary, treatment of chronic myeloid leukaemia is highly effective and focused on targeted inhibition of the disease-driving gene. With proper adherence and regular monitoring, most patients can live normal, active lives.
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