Acute myeloid leukemia in patients older than 60 years, treatment and potential role of allogeneic hematopoietic stem cell transplantation [Akutní myeloidní leukemie u nemocných nad 60 let, možnosti její léčby a potenciální role alogenní transplantace krvetvorných buněk]
Karas M.,Hematologicko onkologicke oddeleni FN Plzen
Onkologie | Year: 2011
Acute myeloid leukemia (AML) is disease of older age with the median of age at diagnosis 69 years. Unfortunately results of intensive treatment of patients older than 60 years with AML, thus patients with high-risk of AML development, are unsatisfactory. The reasons for this unsatisfactory results are higher risks of treatment-related mortality among older patients treated with intensive chemotherapy and biological characteristics of AML in older age with higher risk of AML resistance to intensive treatment and higher risk of AML relapse. According to published data reduced-intensity allogeneic transplantation as part of consolidation treatment and advancement in supportive care after transplantation can improve outcome of patients older than 60 years with AML. The limitation of this strategy is a fact that majority of older patients cannot undergo allogeneic transplantation due to unsatisfactory control of AML or due to diminished performance status which does not alow transplant procedure. New approaches to AML treatment and future improvements in transplant procedure could potentially increase the role of allogeneic transplantation in treatment of patients older than 60 years with AML.
Discontinuation of biological therapy with tyrosine kinase inhibitors in chronic myeloid leukemia patients [Koncept preřušení biologické léčby tyrozinkinázovými inhibitory u chronické myeloidní leukemie]
Dvorak P.,Ustav lekarske genetiky LF UK |
Lysak D.,Hematologicko onkologicke oddeleni FN Plzen |
Vokurka S.,Hematologicko onkologicke oddeleni FN Plzen |
Vozobulova V.,Hematologicko onkologicke oddeleni FN Plzen
Onkologie (Czech Republic) | Year: 2014
Imatinib mesylate, the first tyrosine kinase inhibitor (TKI) approved for the treatment of chronic myeloid leukemia (CML), became the standard of care, induces durable responses and prolongs event-free survival and progression-free survival. However, if TKI therapy is required indefinitely, then this ongoing drug exposure raises its own problems. Long-term follow-up indicates that an increasing proportion of patients treated with TKI have prompt cytogenetic response and achieve reductions in BCR-ABL1 transcripts to a level that is undetectable by very sensitive molecular genetic methods. Observation of the stability of such responses over long follow-up suggests that such patients may be "functionally cured" of CML and thus potentially eligible for TKI therapy discontinuation. At present, therapy discontinuation in CML is not recommended in routine practice and is under active investigation in several clinical studies worldwide. Many questions remain regarding definition of "functional cure" in CML, which patients are most eligible for safe therapy discontinuation, and what management strategies are recommended post discontinuation, especially regarding subsequent molecular relapse.