Treating CML

The immediate goal of therapy in patients with Ph+ CML is to stabilize blood counts and achieve hematological and cytogenetic response.

The achievement of optimal results with CML treatment in all stages of the disease depends on continuous and adequate dosing of the therapeutic agent. Optimal response also requires patient adherence to targeted CML treatment, which is a critical issue in the setting of oral cancer therapy.

Reinforcing with patients the importance of taking the full prescribed daily dose is an essential component of overall management, as is monitoring for potential obstacles to adherence and persistence, such as adverse events. In the event that economic barriers constrain adherence to CML treatment, clinicians and patients should check with the manufacturer about the availability of a patient assistance program.

CML Treatment Goals

Objectives: Stabilise blood counts Haematological response Cytogenetic Response Molecular response

Haematological    Response: Normalise WBC counts Eliminate immature myeloid cells Eradicate signs and symptoms of disease Maintain response for >4 weeks

Cytogenetic    Response: Complete cytogenetic response — elimination of the Ph chromosome Partial cytogenetic response — 1% to 35% Ph+ cells Major cytogenetic response = complete cytogenetic response + partial cytogenetic response

Molecular    Response: Standarization studies are ongoing and definitions of molecular response currently vary Complete molecular response — no detectable bcr-abl transcripts by RT-PCR Major molecular response — ≥3-log reduction in the level of bcr-abl transcripts or bcr-abl/abl ratio ≤0.05%

Next: Targeting Bcr-Abl in CML