Combination of imatinib and anagrelide in treatment of chronic myeloid leukemia in blastic phase
Authors:
J. Voglová 1; V. Maisnar 1; M. Beránek 2; L. Chrobák 1
Authors‘ workplace:
Oddělení klinické hematologie II. interní kliniky Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc.
1; Ústav klinické biochemie a diagnostiky Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Vladimír Palička, CSc.
2
Published in:
Vnitř Lék 2006; 52(9): 819-822
Category:
Case Report
Overview
Chronic myeloid leukemia in blast phase (BP) is resistant to chemotherapy and majority of patients die within 6 months. Inhibitor Bcr-Abl tyrosine kinase imatinib mesylate dramatically improved outcome of patients in chronic phase (CP) and is also effective in BP of CML. The prognosis of patients treated with imatinib in BP is worse than in CP. High platelet counts are often observed at diagnosis or in the subsequent course of the CML in about 25 % of patients. Thrombohemorrhagic complications associated with the thrombocythemia may be serious. Anagrelide selectively reduces circulating platelets and is used in treatment of thrombocythemia in chronic myeloproliferative disorders. Efficacy and safety of combination imatinib mesylate with anagrelide was demonstrated in chronic and accelerated phase of CML. No study about the use of imatinib with anagrelide in BP has been found. 51-year-old white man with CML presented in blast phase was followed for 4 years. Imatinib mesylate in dose of 600 mg p.o. qd. was administered after the failure of initial chemotherapy. The patient was treated with imatinib for 45 months, 14.5 months in combination with anagrelide. Partial hematologic response in duration of 33 months was induced by imatinib, cytogenetic response was not reached. Imatinib-resistant thrombocythemia was controlled with anagrelide in dose of 0.5 - 1 mg p.o. qd. No thrombohemorrhagic complications were observed. The patient tolerated the combination of imatinib and anagrelide well and long-term survival gave him the chance of treatment with the new tyrosin kinase inhibitor (Dasatinib).
Key words:
chronic myeloid leukemia - blast phase - imatinib - anagrelide - therapy - thrombocythemia
Sources
1. Anstrom KJ, Reed SD, Allen AS et al. Long-term survival estimates for imatinib versus interferon-alfa plus low-dose cytarabine for patients with newly diagnosed chronic-phase chronic myeloid leukemia. Cancer 2004; 101: 2584-2592.
2. Mauro MJ, Deininger MWN. Chronic myeloid leukemia in 2006: a perspective. Haematologica/the hematology journal 2006; 91: 151-158.
3. Faber E. Chronická myeloidní leukemie. Leukemie. Praha, Grada Publishing, 2002, 300-311.
4. Cohen MH, Johnson RJ, Pazdur R. U.S. Food and drug administration drug approval summary: Conversion of Imatinib mesylate (STI571; Gleevec) tablets from accelerated approval to full approval. Clin Cancer Res 2005; 11: 12-19.
5. Trapp OM, Beykirch MK, Petrides PE. Anagrelide for treatment of patients with chronic myelogenous leukemia and a high platelet count. Blood Cells Mol Dis 1998; 24: 9-13.
6. Mason JE, DeVita VT, Canellos GP. Thrombocytosis in chronic granulocytic leukemia: incidence and clinical significance. Blood 1974; 44: 483-487.
7. Penka M, Schwarz J, Pytlík R et al. Doporučený postup diagnostiky a terapie esenciální trombocytemie a trombocytopenie provázející jiné myeloproliferativní choroby. Vnitř Lék 2005; 51: 741-751.
8. Tsimberidou AM, Colburn DE, Welch MA et al. Anagrelide and imatinib mesylate combination therapy in patients with chronic myeloproliferative disorders. Cancer Chemother Pharmacol 2003; 52: 229-234.
9. Beránek M, Voglová J, Žák P et al. Quantification of BCR-ABL transcripts by real-time PCR in leukemia samples. Klin Biochem Metab 2004; 12: 147-151.
10. Sacchi S, Kantarjian MH, O’Brien S et al. Chronic myelogenous leukemia in nonlymphoid blastic phase. Analysis of the results of first salvage therapy with three different treatment approches for 162 patients. Cancer 1999; 86: 2632-2641.
11. Talpaz M. Advanced course on leukemia. 26. - 28. 10. 2005, Houston, Texas, ústní sdělení.
12. Silver RT. Anagrelide is effective in treating patients with hydroxyurea-resistant thrombocytosis in patients with chronic myeloid leukemia. Leukemia 2005; 19: 39-43.
13. Wehmeier A, Daum I, Jamin H et al. Incidence and clinical risk factors for bleeding and thrombotic complications in myeloproliferative disorders. A retrospectrive analysis of 260 patients. Ann hematol 1991; 63: 101-106.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2006 Issue 9
Most read in this issue
- MELD score in prediction of early mortality in patients suffering refractory ascites treated by TIPS
- Chronic autoimmune thyroiditis and connective tissue system diseases
- Diuretics in therapy of „diuretic resistance“ by patients with congestive heart failure
- Tumor angiogenesis