Professional paper

Diagnosis and Therapy for Patients with Philadelphia positive chronic myeloid leukemia – Guidelines of Croatian cooperative group for hematologic disorders (Krohem)

Boris Labar ; Zavod za hematologiju, Klinika za unutarnje bolesti, KBC Zagreb, Zagreb, Hrvatska
Dubravka Sertić ; Zavod za hematologiju, Klinika za unutarnje bolesti, KBC Zagreb, Zagreb, Hrvatska
Sanja Davidović ; Citogenetski laboratorij, Klinika za dječje bolesti, KBC Zagreb, Zagreb, Hrvatska
Renata Zadro ; Klinički zavod za laboratorijsku dijagnostiku, KBC Zagreb, Zagreb, Hrvatska
Ružica Lasan-Trčić ; Citogenetski laboratorij, Klinika za dječje bolesti, KBC Zagreb, Zagreb
Rajko Kušec ; Zavod za hematologiju, Klinika za unutarnje bolesti, KB Dubrava, Zagreb, Hrvatska
Branimir Jakšić ; Zavod za hematologiju, Klinika za unutarnje bolesti, KB Merkur Zagreb, Zagreb, Hrvatska
Ljubica Škare-Librenjak ; Zavod za hematologiju, Klinika za unutarnje bolesti, KBC Split, Split, Hrvatska
Antica Duletić-Načinović ; Zavod za hematologiju, Klinika za unutarnje bolesti, KBC Rijeka, Rijeka, Hrvatska
Jasminka Petričević-Sinčić ; Zavod za hematologiju, Klinika za unutarnje bolesti, KBC Osijek, Osijek, Hrvatska
Dubravka Čaržavec ; Zavod za hematologiju, Klinika za unutarnje bolesti, KB “Sestre milosrdnice”, Zagreb, Hrvatska
Velka Gverić-Krečak ; Internistički odjel, OB Šibenik, Šibenik, Hrvatska
Božena Coha ; Internistički odjel, OB “Josip Benčević”, Slavonski Brod, Hrvatska
Elizabeta Čorović ; Internistički odjel, OB Dubrovnik, Dubrovnik, Hrvatska
Zlata Nemet-Lojan ; Internistički odjel, OB Koprivnica, Koprivnica, Hrvatska
Renata Babok-Flegarić ; Internistički odjel, OB Varaždin, Varaždin, Hrvatska

Abstract

Aim: Guidelines for diagnosis and therapy of Philadelphia positive chronic myeloid leukemia are proposed by Croatian cooperative group for hematological diseases – Krohem. Methods: Diagnosis and classification of CML is based on the criteria proposed by WHO. The level of treatment recommendation is based on the UpToDate® (web based medical community database) criteria. Results: For CML diagnosis it is mandatory to prove the Philadelphia chromosome with G-banding technique or to prove BCR-ABL transcript by FISH method or molecular analysis. Tyrosine kinase inhibitors (TKI) are treatment of choice for CML. A significantly better antileukemic activity is associated with dasatinib or nilotinib therapy compared to imatinib. But these drugs are not available for first line therapy in Croatia. Because of that imatinib is still the first line therapy. For second line therapy patients should receive dasatinib or nilotinib depending on the previous therapy. In accelerated phase or blastic crisis allogeneic stem cell transplantation is the treatment of choice. Before transplant, tyrosine kinase inhibitors should be given to decrease the leukemic mass. Patients with T315I mutation are resistant to TKI and should be also allografted. Discussion and conclusion: TKI are the treatment of choice for Ph+ CML in chronic phase. Patients with optimal response are long-term survivors with a good quality of life. In advanced phase of CML or in patients with T315I mutation stem cell transplantation is the treatment of choice.

Keywords

allogeneic stem cell transplantation; giudelines for diagnosis and therapy of Ph+ CML; tyrosine kinase inhibitors

Hrčak ID:

76674

URI

https://hrcak.srce.hr/76674

Publication date:

1.12.2011.

Article data in other languages: croatian

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