Chronic Leukemia

Whats the difference between Acute and Chronic Leukemia?

Acute has IMMATURE WBC and Chronic has MATURE WBC

What is chronic myeloid Leukemia?

Indolent form of myeloprolifeartive leukemiaThe First malignant disease identified with a consistent cytogenetic abnormality. (Long time to die, Slow growing)

What is the average age of CML?

67 years old

What increases the risk of CML?

Exposure to ionizing radiation* Is not associated with heredity, Geography, ethnicity, or socioeconomics

How common is the Philadelphia Chromosome (t;9:22) in CML?

95%

What is conal disease?

Malignant transforamtuon of single pluripotent stem cell

Disrupted maturation?

Additional divisions by CML progenitor cells before reaching a non-proliferative stage

Where does Adenosine triphosphate (ATP) bind?

On the BCR-ABL tyrosine kinase binding site

what are the three phases of CML?

chronic, accelerated, blast

Signs and symptoms of CML?

Fatigue, sweating, bone pain, weight loss, abdominal discomfort, early satiety, Hepatomegaly, Splenomegaly, Thrombocytosis or thrombocytopenia, anemia, Leukocytosis- Clotting disorder.

which phase has the most patients?

90% in the chronic phase

Criteria for the Chronic phase?

<10% Blasts in the peripheral blood or bone marrow

Criteria for the accelerated phase?

Peripheral blood myeloblasts >15% and <30%Platelet count <100 X10L unrealted to therapyAdditional clonal cytogenetic abnormalities in Ph+ cells

Criteria for the blast crisis?

>30% blasts in the blood, marrow, or bothExtramedullary infiltrates of leukemic cellsResembles acute leukemia 1/3 lymphoid lineage2/3 Myeloid lineage

what are the treatment goal for CML?

Maintain Chronic phase with minimal toxicityEradicate leukemia clone from bone marrow

What is the treatment for Neutropenia in CML?

is it disease/treatment related?Hold until RecoveryConsider dose reductionMyeloid growth factor may be considered

What is an appropriate counseling point for imatinib?

Monitor for s/s bleeding

What is the typical duration of TKI therapy?

Until loss of response or unacceptable toxicity

how long does withdrawal symtpoms take to resolve?

1-3 months after reinitation

Is the TKI therapy interchangable?

Yes, imatinib at presentation and then they are interchangeable.