Chronic Myeloid Leukemia (CML)

Please note - The Chronic Myeloid Leukemia (CML) Knowledge Centre is for Doctors and other Healthcare Professionals.

The World Health Organization (WHO) classifies chronic myeloid leukaemia (CML) as a myeloproliferative disease characterised by the presence of the Philadelphia chromosome (Ph) or the BCR-ABL fusion oncogene¹. The diagnosis is generally easily made on the basis of morphological examination of a peripheral blood smear, but confirming genetic studies have become essential with the advent of molecularly targeted therapy.

Leukaemias account for 300,000 new cases (~3% of all new cancer cases) each year and 220,000 deaths worldwide⁷. CML accounts for about 15%-20% of all adult leukaemias and occurs slightly more frequently in men than in women (incidence ratio: 1.4 to 2.2:1)^8-11.

Chronic myeloid leukemia typically progresses through 3 stages or phases. Most patients present in chronic phase, deteriorate during the subsequent accelerated phase, and finally progress to a brief terminal phase, blast crisis. Although the lengths of the phases were altered by previous therapies, the clinical course and natural history of CML had not been changed before the molecular era.

Within the treatment section we examine the following treatment options:

• Chemotherapy
• Interferon Alfa
• Stem-cell Transplantation

Advances in the investigation of the molecular biology of cancer over several decades have made it possible to rationally design drugs to target oncogenic events with unprecedented specificity⁶.

Enter the Chronic Myeloid Leukemia (CML) Knowledge Centre

What’s in the Chronic Myeloid Leukemia (CML) Knowledge Centre?

• CML Home
• CML Management - Diagnosis
• Current Treatment Options
• ELN Recommendations
• Historical Perspective - Chemotherapy
• Historical Perspective - Interferon Alfa
• Historical Perspective - Stem-Cell Transplantation
• Ongoing Management
• Other Therapeutic Approaches
• Prognosis - Goals of Therapy
• Prognosis
• Treatment - historical perspective
• Resources - Imatinib
• Resources - Nilotinib
• Useful Links (General)
• Efficacy: Phase I
• Efficacy: Phase II
• Imatinib - Clinical Efficacy
• Imatinib - Glivec
• Imatinib - Indication
• Imatinib - Mechanism of Action
• Imatinib - Rationale
• Imatinib - Safety Information
• Nilotinib- Adverse Events
• Nilotinib - Mechanism of Action
• Nilotinib- Preclinical Studies
• Nilotinib- Rationale
• Nilotinib - Response Criteria
• Nilotinib- Safety information
• Nilotinib - Tasigna
• Clinical Presentation
• Epidemiology
• Haematological Malignancy and Leukaemia
• Pathophysiology
• Phases of Disease
• Understanding CML - Haematopoiesis

References:
1. Vardiman JW, Harris NL, Brunning RD. The World Health Organization (WHO) classification of the myeloid neoplasms. Blood. 2002;100:2292-2302.
2. Baccarani M, Saglio G, Goldman J, et al. Evolving concepts in the management of chronic myeloid leukemia. Recommendations from an expert panel on behalf of the European LeukemiaNet. Blood. 2006;108:1809-1820.
3. Cortes J. Natural history and staging of chronic myelogenous leukemia. Hematol Oncol Clin North Am. 2004;18:569-584.
4. Druker BJ, Guilhot F, O'Brien S, Larson RA, on behalf of the IRIS. Long-term benefits of imatinib (IM) for patients newly diagnosed with chronic myelogenous leukemia in chronic phase (CML-CP): the 5-year update from the IRIS study [abstract]. J Clin Oncol. 2006;24:338s. Abstract 6506. Oral presentation.
5. Druker BJ, Guilhot F, O'Brien SG, et al. Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med. 2006;355:2408-2417.
6. Druker BJ. Perspectives on the development of a molecularly targeted agent. Cancer Cell. 2002;1:31-36.
7. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74-108.
8. Druker BJ. Perspectives on the development of a molecularly targeted agent. Cancer Cell. 2002;1:31-36.
9. Greenlee RT, Hill-Harmon MB , Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin. 2001;51:15-36.
10. Ries LAG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1975-2001. National Cancer Institute. Available at: http://seer.cancer.gov July 15, 2005.
11. Cortes J. Natural history and staging of chronic myelogenous leukemia. Hematol Oncol Clin North Am. 2004;18:569-584.