Frequently Asked Questions About Chronic Myeloid Leukemia | CML Alliance
CML Alliance
For Healthcare Professionals Outside the US  
 
Send to a friend Print this page Change Text Size  

About CML Alliance
Frequently Asked Questions
Treating CML
Targeted Therapies and CML
Monitoring Treatment & Response
CML Resources
CML Events
CML Clinical Trials
Novartis' Commitment to the Global CML Community
CML Alliance Patient Initiative
  Access educational resources for your patients to help them better understand and manage their CML.
Learn more >

CML Targeted Therapies
  Since its development, Glivec® has been a cornerstone of therapy for CML patients.
Learn more >
 

Frequently Asked Questions




Q1) What is the purpose of the CML Alliance program?


A1) The purpose of CML Alliance is to help healthcare providers who treat Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) and their patients to fully optimize CML therapy.

Q2) Why is the program called CML Alliance?


A2) Novartis sees the program as a true alliance between healthcare providers, patients, and Novartis, dedicated to optimizing therapy in all Ph+ CML patients worldwide.

Q3) Specifically what services are provided through the program?


A3) CML Alliance is a global program that provides CML resources and services to physicians and Ph+ CML patients and is customized in each country in which it is offered. The CML Alliance resources provided in each country vary depending on local legal and regulatory specifications. For specific CML Alliance information and services available in each country, please contact your local Novartis organization.

CML Alliance is an integrated program that builds on support and educational materials that Novartis has provided to healthcare professionals and patients over the years.

For healthcare professionals, the CML Alliance program aims to provide or facilitate access to:

  • Educational information on the molecular biology and management of Ph+ CML
  • Information about CML clinical trials on new investigational agents and existing therapies in CML
  • Reimbursement support services
  • Glivec® blood level and standardized molecular testing

For patients, the CML Alliance program aims to provide or facilitate access to:

  • Unique CML patient support programs designed to help patients better understand CML, its treatment, and the importance of adherence to their CML therapy
  • Reimbursement support services
  • Valuable educational information about living with Ph+CML

Q4) Is the program only for patients receiving Glivec?


A4) Depending on local rules and regulations in each country, CML Alliance is available to all patients with Ph+CML or just those on Glivec.

Q5) Why is Novartis initiating this program now?


A5) CML Alliance is an integrated program that builds on the support and educational materials that Novartis has provided to healthcare professionals and patients over the years.

CML Alliance aims to offer healthcare professionals and patients a wealth of resources, including patient education, access to Glivec blood level and standardized molecular testing, access to reimbursement support services and information on clinical trials with investigational agents and existing therapies in CML.

CML Alliance is part of a broad effort by Novartis to help physicians achieve the best possible outcomes for their Ph+ CML patients receiving targeted therapy.

Q6) Where is CML Alliance being offered?


A6) CML Alliance is a global healthcare professional and Ph+ CML patient support program—the US is the first country in which it is being implemented.

CML Alliance is customized to best meet the needs and regulatory and legal requirements of each country.

Q7) Aren’t a lot of the services offered through CML Alliance already available?


A7) Some of the program elements were previously available. Others, such as Glivec blood level testing, are entirely new.

Novartis believes that the best way to optimize therapy in all CML patients worldwide is to provide these CML resources and services as part of a single, integrated CML Alliance program.

Q8) What about patient confidentiality?


A8) CML Alliance fully complies with all privacy and confidentiality regulations of the countries in which it is implemented. For example, in the US, CML Alliance complies with all HIPAA regulations.

Q9) Are there any costs associated with enrolling in CML Alliance?


A9) No. There are no costs associated with enrolling in the CML Alliance.

Q10) How can Ph+CML patients and their healthcare providers find out more about CML Alliance or enroll in it?


A10) For general information about the program, please visit the global CML Alliance website at CMLAlliance.net. For specific enrollment into the program, please contact your local Novartis office.

Enrollment in CML Alliance is voluntary. Healthcare providers and patients are under no obligation to enroll or maintain their participation in the program.

Q11) Why test Glivec blood levels?


A11) Blood level testing may play an important role in optimizing Glivec (imatinib) therapy. There are a number of factors that affect Glivec blood levels, such as drug-drug interactions and adherence.

Q12) What is the issue with nonadherence?


A12) Targeted oral therapies such as Glivec (imatinib) are relatively new in oncology—and it has only recently begun to be recognized that adherence to therapy may be an issue with targeted oral oncology drugs. A large study of adherence to oral cancer medication was conducted with Glivec.1 This study showed that:

  • On average, patients (N = 4043) took only 75% of their prescribed Glivec over the 24-month study period
  • Patients were on therapy an average of only 62% of the study period (255 days out of 24 months)
  • Adherence began to decline after 4 months of treatment

In another study, it was shown that patients may overestimate their adherence to oral cancer therapies by a factor of 2 in discussions with their physicians.2

This may be an even more significant issue in diseases where many patients on therapy never had, or no longer experience any overt symptoms of their disease and may, over time, forget how important it is to take their therapy exactly as prescribed.

Q13) Are there any costs to Ph+CML patients or healthcare providers associated with Glivec blood level testing?


A13) Glivec blood level testing provided by Novartis is not available in every country in which the CML Alliance Program is offered. For specific information and services that are available in each country, please contact your local Novartis organization.

Where permissible under local laws and regulations, for all patients who are on Glivec therapy and enrolled in CML Alliance, Glivec blood level testing will be performed free of charge. Shipping of samples is also free for all Glivec blood level testing performed through CML Alliance.

The cost of the actual doctor’s visit and blood draw are not covered by CML Alliance.

Q14) Can healthcare providers use this program to test blood levels of dasatinib or nilotinib?


A14) No.

Q15) Why measure molecular response in patients with Ph+ CML?


A15) Ph+CML patients treated with Glivec as first-line therapy tend to achieve high overall rates of complete hematologic and cytogenetic response.3 The degree of Glivec efficacy was therefore explored by measuring trace levels of Bcr-Abl transcripts4(molecular response) to assess whether a patient with Ph+ CML has achieved or is trending towards a desired response to therapy and to ensure that a patient’s treatment is optimized over time.

Molecular response has been found to correlate with both cytogenetic response5,6 and long-term progression-free survival.7,8 In the IRIS trial, 53% of Ph+ CML patients who had complete cytogenetic response achieved major molecular response after one year on Glivec and at 4 years, 80% of these patients had reached this milestone.9

Q16) How is molecular response to Ph+ CML therapy tested?


A16) The best way to assess whether a patient has achieved and is maintaining a molecular response is by “real-time” quantitative polymerase chain reaction (RQ-PCR).10 However, currently results can differ considerably between labs, making interpretation and practical application difficult.

Q17) How does the CML Alliance plan to test molecular response?


A17) For specific information and services available in each country, please contact your local Novartis organization.

Where permissible under local laws and regulations, CML Alliance will offer PCR testing in certified laboratories with significant expertise in PCR, based on a standardized molecular monitoring and reporting standards for PCR testing so that physician can have access to consistent and easily interpretable PCR results for better management of Ph+ CML patients.

Q18) Are these tests available globally as part of this program?


A18) CML Alliance is a global program that will be customized to best meet the needs and regulatory and legal requirements of each country.

References

  1. Tsang JP et al. J Clin Oncol. 2006;24. Abstract 6119.
  2. Partridge AH, Avorn J, Wang PS, et al. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst. 2002;94:652-661.
  3. O'Brien SG, Guilhot F, Larson RA, et al. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2003;348:994-1004.
  4. Hughes TP, Kaeda J, Branford S, et al. Frequency of major molecular responses to imatinib or interferon alfa plus cytarabine in newly diagnosed chronic myeloid leukemia. N Engl J Med. 2003;349:1423-1432].
  5. Branford S, Rudzki Z, Harper A, et al. Imatinib produces significantly superior molecular responses compared to interferon alfa plus cytarabine in patients with newly diagnosed chronic myeloid leukemia in chronic phase.Leukemia. 2003;17:2401-2409.
  6. Ross DM, Branford S, Moore S, et al. Leukemia. 2006;20:664-670.
  7. Druker BJ. Semin Hematol. 2003;40:50-58.
  8. Kantarjian HM, O'Brien S, Cortes JE, et al. Complete cytogenetic and molecular responses to interferon-alphabased therapy for chronic myelogenous leukemia are associated with excellent long-term prognosis. Cancer. 2003;97:1033-1041.
  9. Druker BJ, Guilhot F, O'Brien SG, et al. for the IRIS investigators. Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med. 2006. Pg.2412
  10. Hughes T, Deininger M, Hochhaus A, et al. Monitoring CML patients responding to treatment with tyrosine kinase inhibitors: review and recommendations for harmonizing current methodology for detecting BCR-ABL transcripts and kinase domain mutations and for expressing results. Blood. 2006 Jul 1;108(1):28-37.
 
Novartis Oncology