Question

Outline an optimal treatment plan for a patient with CML and explain your reasoning discuss the trade off encountered during the composition of your plan consider alternative drug targets in a bone marrow transplant

Answer 1

BOSULIF (bosutinib) is a prescription medicine used to treat adults who have a type of leukemia called Philadelphia chromosome–positive chronic myelogenous leukemia (Ph+ CML) who no longer benefit from or did not tolerate other treatment.

Monitoring the patient to see how they respond to treatment is very important. Blood counts are checked often. The blood is also checked with a polymerase chain reaction (PCR) test to measure the amount of the BCR-ABL gene. The bone marrow is checked, too, to see if the Philadelphia chromosome is there. Testing for the BCR-ABL gene or the Philadelphia chromosome is usually done about 3 months after a TKI is started, and then every 3 to 6 months after that. If the results show that treatment is working well, the patient stays on their current drug. If the results show that treatment isn’t working well, and the patient is taking the drug the way they should, a new drug or treatment may be needed.

If the CML is responding well to treatment, 3 months after starting treatment, the patient should have:

A complete hematologic response (CHR), andS ome type of cytogenetic response, and/or

A reduction of the number of copies of BCR-ABL on the PCR test by 90% or more

If treatment is working well, 18 months after starting treatment, the patient should have:

A complete hematologic response (CHR), and

A complete cytogenetic response (CCyR), and/or

A major molecular response (MMR)

CML is a cancer of the bone marrow. It’s also called chronic myelogenous leukemia.

CML is caused by an abnormal chromosome in bone marrow cells called the Philadelphia chromosome. Chromosomes carry instructions that tell the body how to make everything it needs to work properly. The Philadelphia chromosome tells the bone marrow to make too many white blood cells. Doctors don’t know what causes the Philadelphia chromosome.

The 3 phases of CML

CML has 3 phases:

Chronic phase – Most patients are diagnosed in this phase and often do not have any symptoms. During this phase, there are too many immature white blood cells (blasts) in the bone marrow, blood and spleen. Without treatment, the CML will move into the accelerated phase.

Accelerated phase – During this phase, the number of blasts increase and the spleen gets bigger. Patients may have fevers, night sweats, weight loss and increasing fatigue.

Blast phase – During this phase, the number of blasts in the blood stream grows quickly. This causes fewer normal blood cells (white blood cells, red blood cells and platelets). Patients may have very high fevers, night sweats, weight loss, shortness of breath, bruises, bleeding and infections.