Furthermore, they wrote, “Patients treated with the combination of a TKI with chemotherapy were found to have superior outcomes compared with patients treated with a TKI alone or with non-TKI-based treatments.”

The molecular aberrations the authors found that correlated with inferior survival outcomes open new avenues of exploration. But, for the moment at least, offer little in the way of effective therapeutic strategies.

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“The molecular abnormalities that we identified are ones where we don’t yet have specific treatments for,” Dr Cortes said.

Still, when 1 of his patients presents with blast phase CML, “I don’t tell them that there is nothing to do. Because there are things I can do,” he said. “I explain that this disease is a more aggressive disease and therefore my treatment has to be more aggressive. It frequently includes chemotherapy and transplants and things that we were not talking about when we were in the chronic phase.

“I never want to take away their hope, but I do make it very clear that we are facing a much more difficult enemy and the prognosis is not as good.”

He finds promise, he said, in the success of therapeutic advances in treating non-blast phase CML, and in decreasing the incidence of the disease’s progression. Now, though, he wishes for similar success against its most intractable form. “One of my goals with this exercise was to bring to the attention of the CML community that we’re not doing enough for the patients who do progress,” he said. “I think we need to pay more attention everywhere from understanding the biology to designing better treatment.”

Thankfully, he noted, that has already begun, to a degree. “Several clinical trials are looking at better ways to manage patients with blast phase CML and focusing on new approaches that we hope will improve the outcome in the near future,” Dr Cortes concluded.

References

  1. Jain P, Kantarjian H, Ghorab A, Sasaki K, Jabbour  E, Gonzalez GN, et. al. Prognostic Factors and Survival Outcomes in Patients With Chronic Myeloid Leukemia in Blast Phase in the Tyrosine Kinase Inhibitor Era: Cohort Study of 477 Patients. Cancer. 2017 Jul 25. doi: 10.1002/cncr.30864. [Epub ahead of print]
  2. Hehlmann R, Saussele S. Treatment Of Chronic Myeloid Leukemia In Blast Crisis. Haematologica. December 2008 93: 1765-1769; Doi:10.3324/haematol.2008.001214
  3. Radich J, A New Remedy for Blast-Crisis CML? The Hematologist.November-December 2010, Volume 7, Issue 6.  November 01, 2010

Topics:

Chronic Myeloid Leukemia Hematologic Cancers Leukemia