The 2010 Government Supported Benefits 'Virtual' Summit
A unique web-based conference and series of accredited on-line self-learning programs focused on the impact of Heathcare reform on providers and patient care.

Chronic Myelogenous Leukemia (CML): Evolving Treatment Patterns

Needs Assessment:

CML is a cancer that originates from the cells within the bone marrow that produce white blood cells.  CML typically presents in middle-aged adults and in children.  The disease affects 1 to 2 people per 100,000 and represents 7 to 20% of all leukemia cases. In the U.S., there are about 4,500 people diagnosed each year.  CML causes rapid growth of immature blood-forming cells (myeloid precursors) in the bone marrow, blood and body tissues.  Left untreated, CML results in bleeding and infection due to bone marrow failure.  A decade ago, fewer than half of CML patients remained alive seven years after their diagnosis.  With the introduction of the first-generation tyrosine kinase inhibitor imatinib (Gleevec), overall 7-year survival in CML is nearly 90% (1-7).  Despite the success of imatinib, there are nearly 20 to 25% of CML patients that fail to respond to imatinib or experience intolerable side effects.   

Currently, in the U.S., there are two agents that have been approved as second-line therapies for CML: dasatinib (Sprycel) and nilotinib (Tasigna).  Two recent studies (8) with these agents have demonstrated even better responses than imatinib in previously untreated CML patients with diminished toxicities.  Interestingly, a recent study (9) may have uncovered a new lab test that can identify patients most likely to be resistant to imatinib therapy.  Despite the successes seen with the current treatments for managing CML, there remain challenges ahead.  It is unclear if any of the current therapies achieve long-term remission and even in patients where disease is undetectable, CML relapses occur.  Long-term maintenance therapy is therefore recommended, however, side effects may develop or patients can no longer afford these medications long-term.  Research is ongoing to find additional treatment options.

Learning Objectives:

• To review the disease pathogenesis for CML and describe the current treatment options for patients with CML

• To understand the mechanism of action of the current therapies and how that relates to their difference in efficacy and side effects in treating patients with CML.

• To examine the current research in CML and understand how this will impact the future treatment of patients with CML.

 Agenda

• Disclosures and Introduction (2 minutes)
• The disease pathogenesis for CML and current treatment options for patients with CML (20 minutes)
• The mechanism of action of current therapies, their difference in efficacy, and side effects (20 minutes)
• Current research in CML and how this will impact the future treatment of patients with CML (15 minutes)
• References, Summary and Conclusions (3 min)