How I treat CML blast crisis

• Verfasst von: Hehlmann, Rüdiger [VerfasserIn]
• Titel: How I treat CML blast crisis
• Verf.angabe: Rüdiger Hehlmann
• E-Jahr: 2012
• Jahr: May 31, 2012
• Umfang: 11 S.
• Fussnoten: Gesehen am 06.04.2018
• Titel Quelle: Enthalten in: Blood
• Ort Quelle: Washington, DC : American Society of Hematology, 1946
• Jahr Quelle: 2012
• Band/Heft Quelle: 120(2012), 4, Seite 737-747
• ISSN Quelle: 1528-0020
• DOI: doi:10.1182/blood-2012-03-380147
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1571784993

Abstract

Blast crisis (BC) remains the major challenge in the management of chronic myeloid leukemia (CML). It is now generally accepted that BC is the consequence of continued BCR-ABL activity leading to genetic instability, DNA damage, and impaired DNA repair. Most patients with BC carry multiple mutations, and up to 80% show additional chromosomal aberrations in a nonrandom pattern. Treatment with tyrosine kinase inhibitors has improved survival in BC modestly, but most long-term survivors are those who have been transplanted. Patients in BC should be treated with a tyrosine kinase inhibitor according to mutation profile, with or without chemotherapy, with the goal of achieving a second chronic phase and proceeding to allogeneic stem cell transplantation as quickly as possible. Although long-term remissions are rare, allogeneic stem cell transplantation provides the best chance of a cure in BC. Investigational agents are not likely to provide an alternative in the near future. In view of these limited options, prevention of BC by a rigorous and early elimination of BCR-ABL is recommended. Early response indicators should be used to select patients for alternative therapies and early transplantation. Every attempt should be made to reduce or eliminate BCR-ABL consistent with good patient care as far as possible.