By Peter W. Marks, MD, PhD

2009-12-06

In our second-year medical school hematology module at Yale, we use chronic myeloid leukemia (CML) as a paradigm for what is possible when a disease is well-understood at the molecular level. The clinical impact the BCR-ABL translocation in CML diagnosis, treatment, and monitoring of therapy illustrates what we hope to accomplish with other diseases. And yet, despite our tremendous recent success in CML, there is still room for improvement in therapy. The Education Program Session, Chronic Myeloid Leukemia: After a Decade of Imatinib, which was presented yesterday from 9:30 to 11:00 a.m. and will be presented again today from 7:30 to 9:00 a.m. in Hall F of the Ernest N. Morial Convention Center, gives an excellent overview of current challenges in CML treatment and disease monitoring.

Dr. Brian Drucker, who chairs the session, notes that, “CML has been converted into a chronic, manageable condition for most patients.” This has occurred over the course of a just decade since initial data on imatinib were presented here in New Orleans.

Dr. John Goldman from Imperial College London and the Hammersmith Hospital will then review the current treatment of CML, including options for initial therapy for newly diagnosed patients and key decision points as patients progress through their clinical course. He will discuss which BCR-ABL kinase inhibitor should be first-line therapy in 2009 and what physicians can expect from therapy with imatinib or other agents.

The addition of dasatinib and nilotinib to the therapeutic armamentarium for the treatment of CML has naturally led to a discussion about where these agents fit in disease management algorithms. Dr. Moshe Talpaz from the University of Michigan in Ann Arbor will continue the session by discussing these agents and other compounds in development that may be considered when CML fails to respond adequately to approved therapies.

In the final talk, Dr. Timothy Hughes of SA Pathology in Adelaide, South Australia, will discuss molecular monitoring of disease response in CML. Understanding how to interpret the results of such testing is of critical importance for appropriately treating patients and can help clinicians decide when to continue an effective therapy and when to switch to a new one.

This session illustrates just how far we have come in the treatment of CML in a brief period of time. It is also clear that there is some room for us to further improve our management of this disease.

Dr. Marks indicated no relevant conflicts of interest.

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