Chronic myeloid leukemia, previously also known as chronic granulocytic leukemia, is a neoplastic disease of pluripotent stem cell origin with a characteristic Philadelphia chromosome (Ph chromosome), and the resulting BCR/ABL fusion gene is the key causative factor of the disease. It is clinically characterized by a significant increase in peripheral blood granulocytes with the appearance of naïve granulocytes and a markedly enlarged spleen. The natural course of the disease consists of three phases: chronic, accelerated and acute phases. Chronic granulocytic leukemia accounts for about 20%-35% of all leukemias and 90% of chronic leukemias. The incidence rises gradually with age, with a median age at diagnosis of 45-50 years and a peak age of onset of 50-60 years.
Traditional treatment is mainly chemotherapy (hydroxyurea, etc.), interferon and hematopoietic stem cell transplantation. In the late 1990s, the recommended treatment for patients in the chronic phase of initial treatment was still hematopoietic stem cell transplantation and interferon. In recent years, with the elucidation of the pathogenesis of CML and the application of targeted drugs such as tyrosine kinase inhibitors, great progress has been made in the treatment of CML. Patients with chronic myeloid leukemia treated with conventional therapy have an average survival of only 3-5 years, while targeted therapies such as Gleevec can enable patients to have an expected survival of 15-20 years.
Gleevec (imatinib), a targeted therapy drug targeting tyrosine kinases, is currently used as standard first-line therapy and has shown good efficacy and tolerability. Patients in the chronic phase who are traditionally resistant to standard doses of Gleevec may increase the dose of the drug or switch to a second-generation tyrosine kinase inhibitor, such as dasina (nilotinib).
For patients who have failed treatment with second-generation tyrosine kinase inhibitors, or with resistance mutations such as T315I, allogeneic hematopoietic stem cell transplantation may be the most appropriate treatment option. Allogeneic hematopoietic stem cell transplantation can be used as first-line therapy for patients in the accelerated or acute phase and should be performed as soon as possible after obtaining a cytogenetic response to chemotherapy induction.
The goal of treatment for chronic myeloid leukemia is no longer only to achieve hematologic and genetic remission (chromosomal reversion), but more importantly to achieve molecular remission, and only patients with good molecular response can survive in the long term. Therefore, close monitoring of chromosomal and fusion gene changes is an important basis for judging efficacy and making treatment choices. If these tests are neglected, changes in disease cannot be followed up in a timely manner, and there is a lack of accurate evaluation of drug efficacy, treatment selection and efficacy are likely to be affected. Not only the choice of treatment plan, but also the patient’s compliance and the degree of cooperation with treatment will affect the outcome of treatment. Therefore, strengthening the communication of medical information with patients can increase patients’ knowledge of the disease, improve their cooperation with treatment, and facilitate joint efforts between doctors and patients to overcome the disease. The disease, also previously called chronic granulocytic leukemia, is a neoplastic disease originating from pluripotent stem cells with a characteristic Philadelphia chromosome (Ph chromosome), and the resulting BCR/ABL fusion gene is the key causative factor of the disease. It is clinically characterized by a significant increase in peripheral blood granulocytes with the appearance of naïve granulocytes and a markedly enlarged spleen. The natural course of the disease consists of three phases: chronic, accelerated and acute phases. Chronic granulocytic leukemia accounts for about 20%-35% of all leukemias and 90% of chronic leukemias. The incidence rises gradually with age, with a median age at diagnosis of 45-50 years and a peak age of onset of 50-60 years.
Traditional treatment is mainly chemotherapy (hydroxyurea, etc.), interferon and hematopoietic stem cell transplantation. In the late 1990s, the recommended treatment for patients in the chronic phase of initial treatment was still hematopoietic stem cell transplantation and interferon. In recent years, with the elucidation of the pathogenesis of CML and the application of targeted drugs such as tyrosine kinase inhibitors, great progress has been made in the treatment of CML. Patients with chronic myeloid leukemia treated with conventional therapy have an average survival of only 3-5 years, while targeted therapies such as Gleevec can enable patients to have an expected survival of 15-20 years.
Gleevec (imatinib), a targeted therapy drug targeting tyrosine kinases, is currently used as standard first-line therapy and has shown good efficacy and tolerability. Patients in the chronic phase who are traditionally resistant to standard doses of Gleevec may increase the dose of the drug or switch to a second-generation tyrosine kinase inhibitor, such as dasina (nilotinib).
For patients who have failed treatment with second-generation tyrosine kinase inhibitors, or with resistance mutations such as T315I, allogeneic hematopoietic stem cell transplantation may be the most appropriate treatment option. Allogeneic hematopoietic stem cell transplantation can be used as first-line therapy for patients in the accelerated or acute phase and should be performed as soon as possible after obtaining a cytogenetic response to chemotherapy induction.
The goal of treatment for chronic myeloid leukemia is no longer only to achieve hematologic and genetic remission (chromosomal reversion), but more importantly to achieve molecular remission, and only patients with good molecular response can survive in the long term. Therefore, close monitoring of chromosomal and fusion gene changes is an important basis for judging efficacy and making treatment choices. If these tests are neglected, changes in disease cannot be followed up in a timely manner, and there is a lack of accurate evaluation of drug efficacy, treatment selection and efficacy are likely to be affected. Not only the choice of treatment plan, but also the patient’s compliance and the degree of cooperation with treatment will affect the outcome of treatment. Therefore, strengthening the communication of medical information with patients can increase patients’ knowledge of the disease, improve their cooperation with treatment, and facilitate joint efforts between doctors and patients to overcome the disease.