Clinical manifestations, contemporary diagnosis and treatment of chronic myeloid leukemia

Abstract

Introduction: Chronic myeloid leukemia (CML) is a myeloproliferative disorder that results from the reciprocal translocation of the ABL1 gene on chromosome 9 with the BCR gene on chromosome 22, leading to the formation of the chimeric fusion oncogene. This myeloproliferative malignancy accounts 15-20% of leukemias in adults. The course of CML istriphasic: chronic phase (asymptomatic in approximately 30% of cases) followed by an advanced accelerated phase and/or blast crisis, which may prove fatal. The treatment of CML has evolved over the years and currently includes oral tyrosine kinase inhibitors, immunotherapy and bone marrow transplantation. Imatinib was the first tyrosine kinase inhibitor to be introduced as first-line therapy. Purpose and Objectives: Evaluation of clinical manifestations, contemporary methods of diagnosis, assessment of therapeutic possibilities and treatment outcomes in patients with CML. Materials and methods: The study was based on the analysis of the clinical observation sheets of 50 patients diagnosed with CML. Results: The study included 50 patients aged from 20 to 81 years: 28 men (56%) and 22 women (44%). According to the study, CML starts most frequently at the age o f 46-50 years (18%). 46 (92%) patients were diagnosed with CML in chronic phase. Only 3(6%) patients were diagnosed during the acceleration phase and 1 (2%) patient - during the acute phase. 9 (18%) patients were asymptomatic at the moment of diagnose. At least 35 (70%) patients presented a certain degree of splenomegaly; 40 (80%) patients-asthenia, 37 (74%) patients- pressure in the left hypochondrium; 15 (30%) patients- bodyweight loss. 46 (92%) patients received chemotherapy, 37 (74%) patients (74%) were treated with Imatinib. Only 2(4%) patients received Imatinib as a first line therapy. 36 (72%) patients had a complete remission (68% ensured by Imatinib); 14 (28%) patients - partial remission (ensured by conventional therapy). In the first 6 months o f treatment, Imatinibdetermined CMR in 5 (10% ) cases, CCR in 7 (14%) cases and CHR in 22(48%) cases. Only 3(6%) patients experienced a relapse in less than a year after remission with Imatinib. On the other hand,8(16%) patients with conventional therapy experienced recurrence during the same period of time. Conclusion: The tyrosine kinase inhibitors represent the current most efficient therapy for CML in chronic phase. The treatment discontinuation is almost invariably followed by a recurrence. The introduction of targeted therapy has transformed this disease from an incurable malignancy to a manageable chronic condition.