Treatment of chronic myeloid leukemia

The choice of treatment programs myeloid leukemia in Israel will be determined taking into account the phase of the disease, the age and general health. The doctor will discuss treatment options with the patient, the advantages and disadvantages of each.

Targeted treatment of chronic myeloid leukemia in Israel

In the treatment of this disease tyrosine kinase inhibitors are used. These drugs block the action of abnormal gene (BCR-ABL). This means that the leukemic blast cells or under the influence of the treatment will be properly mature and die.

Three drugs are the most common: imatinib (Glivec), dasatinib (spraysel®) and nilotinib (tasigna®).

Imatinib (Glivec)

It is the main drug targeted therapy used in the treatment of chronic myeloid leukemia in all three phases. Taken in pill daily until has an effect and helps to control the disease.

Dasatinib (spraysel®) and nilotinib (tasigna®)

These drugs are considered more new types of tyrosine kinase inhibitors. They are prescribed for the treatment of chronic myeloid leukemia in different phases. They can help people when the side effects of imatinib are very heavy, or it does not have the desired effect.

It is taken orally, for as long as effective.

Side effects of targeted therapy

As a rule, they are quite soft and can be treated. More it pronounced during the first four weeks of therapy, and then go into decline.

After discontinuation of the drugs unwanted effects tend to persist, so if you have severe complications of the treatment of myeloid leukemia may be suspended for a few days. After a short break reception resumes. In some very severe cases, the treatment is completely stopped. Be sure to tell your doctor about any side effects.

  1. Nausea is soft enough degree of manifestation. Antiemetic drugs the doctor prescribes to prevent or reduce it. If one drug does not work, there are other alternatives.
  2. Diarrhea control with medication. If this side effect it is important to drink plenty of fluids.
  3. Loss of appetite. A dietitian can advise on how to improve the appetite, to maintain weight and to cope with difficulties in their diet.
  4. Headache. With this feature, appointed analgesics.
  5. Pain in the muscles, bones and joints may occur during treatment with myeloid leukemia. Painkillers will ease the condition.
  6. Water Retention capable occur in different parts of the body. In most cases, swollen ankles and the area around the eyes. Useful are diuretics that will take part of the fluid in the urine. It can help a short course of steroids.
  7. Changes in the skin include dryness, itching, rash. Needs to consume sufficient liquid. Your doctor may prescribe medications or creams that will ease the condition.
  8. Fatigue and weakness - common side effects, the degree of manifestation of weakly expressed. It should rest as much as the body needs.
  9. Constipation. With him cope with the help of copious drinking, diet high in fiber and light exercise. Sometimes you may need laxatives for bowel stimulation.
  10. the risk of infection. tyrosine kinase inhibitors can reduce the number of healthy white blood cells, which are produced by the bone marrow, which increase the risk of infections. After each course run blood tests. Sometimes therapy lay if the cell count remains low.
  11. Bruising and bleeding arise due to lack of platelets that promote clotting. You must tell your doctor if you experience unexplained bruising and bleeding from the nose, gums, petechial hemorrhages in the skin.
  12. Anemia can be a side effect of treatment of tyrosine kinase inhibitors, marked fatigue and dyspnea. Too low number of red blood cell transfusions of blood or discontinue treatment of chronic myeloid leukemia for several days, until their level is restored. Also, Israeli doctors use injections of substances called growth factors. They stimulate the bone marrow to produce more white blood cell count and erythropoietin, which helps with the synthesis of red blood cells.
  13. Contraception and fertility. tyrosine kinase inhibitors are the new types of drugs, so there is not enough information about the pregnancies during their reception. But there is an increased risk of damage in the developing fetus, so it is strongly recommended to use contraception during treatment of myeloid leukemia.

Monitoring the response to targeted therapy in the clinics of Israel

When the treatment of chronic myeloid leukemia has just begun, you must visit the medical facility every week, later once every two months. During these visits, the doctor queries about the health condition of the appearance of new symptoms or side effects from the therapy. To check the number of blood cells give up clinical and biochemical analyzes, as well as PCR. Occasionally you may need to carry out a bone marrow biopsy.

The results of these tests help the physician to evaluate the body's response to treatment of myeloid leukemia.

response levels

The main goal of therapy - to transfer the disease in remission, when there are no signs of CML in the blood. In order to evaluate the effectiveness of treatment of myeloid leukemia, the body's response is divided into several levels.

hematologic response

In disease detection the number of leukocytes in blood is high. Hematologic response means that the number of blood cells returned to normal, the leukemia segments was found. If the spleen was enlarged, the body back to normal size.

Most people get hematologic response within 3 months after receiving imatinib.

cytogenetic response

This is the next level of response of the organism. It is associated with the number of Philadelphia chromosome (designated Ph +) in the blood and bone marrow. It decreases when the treatment starts to work CML. During the study, studied at least 20 bone marrow cells from the sample taken. There are different levels of cytogenetic response, depending on the percentage of Ph + cells in the bone marrow:

  • Complete response - no Ph + cells.
  • Partial response - from 1 to 35% Ph + cells.
  • Minor response - from 36-65% Ph + cells.
  • The minimum response - from 66 to 95% Ph + cells.
  • Lack of response - more than 95% Ph + cells.

Getting cytogenetic response usually requires more time, sometimes for many months. Almost 80% of patients receive a complete response while taking imatinib to chronic phase CML.

molecular response

This is the next goal of the treatment of chronic myeloid leukemia, when achieved cytogenetic response. Leukemia cells may still be present in the body. In order to identify a blast cells among the many thousands of healthy requires a very sensitive test.

PCR can detect pathologic one segment per 1 000 000 healthy blood cells. It measures the substance (protein bcr-abl, also called transcriptome) that is generated gene BCR-ABL.

PCR was performed during diagnosis statement and every three months during treatment - blood sample is taken. He can find signs of leukemia for many months after initiation of treatment myeloid leukemia, even if the patient feels well.

There are two levels of molecular response:

Complete response means that the PCR test could not detect the BCR-ABL gene in the blood.

Large (primary) response involves the detection of a small amount of BCR-ABL gene in blood.

Continued treatment of chronic myeloid leukemia

The patient continues to be tyrosine kinase inhibitors as drug works and helps to control the disease. This is important even if the PCR does not show any symptoms.

There is a risk if the patient stops treatment of myeloid leukemia, or change the dose without the knowledge of the physician, the malignant cells appear again, and then the body will respond poorly to therapy in the future.

Advice on how to make the administration of drugs part of everyday life or habit:

  • Take pills during the meal - lunch or dinner.
  • Keep the medication in a place that every day is in sight.
  • Mark each dose on the calendar or use the 7-day pill container.
  • Have a supply of medicines while traveling.

Stem cell transplantation in the treatment of myeloid leukemia in Israel

In general it is carried out patients whose body did not respond to treatment tyrosine kinase inhibitors. If the doctor believes that the transplant is necessary or possible, he discussed this issue with the patient.

transplantation process is carried out in a specialized cancer centers. Our medical service will help to choose the most suitable option for patients in Israel.

Transplantation of stem cells allows to obtain higher dose chemotherapy. It may also be carried out irradiation of the whole body, it will increase the chances of a cure or myeloid leukemia achieve maximum long-term remission.

Stem cells are found in bone marrow, on their basis are erythrocytes, leucocytes and platelets. Planning transplant involves collecting stem cells from blood or bone marrow, and store them until a certain time.

There are two types of transplantation:

  1. Allogeneic when the recipient receives the stem cells from another person (donor).
  2. Autologous - the use of their own cells.

CML treatment is carried out with the help of an allogeneic transplant using donor cells. Autologous transplants are generally used in clinical trials.

allogeneic transplantation

The main objective of the graft - to the source of a healthy bone marrow and try to cure the disease. The most suitable donor is usually a brother or sister or other person (no relation), with whom there is a genetic match.

When CML transplant usually carried out during the chronic phase, where the disease is stable. Also, sometimes with end-stage if there is remission.

High-myelogenous leukemia treatment in Israel

The first stage of the treatment of CML involves a high-dose chemotherapy, sometimes in combination with radiation therapy. This destroys the patient's bone marrow.

Some people, especially those who are older and have less fit, this kind of treatment of chronic myeloid leukemia can cause very serious side effects. In such cases, use lower doses of therapy. Held mini-transplant. After chemotherapy (irradiation, if used), donor stem cells arrive through the flow into the body.

The new stem cells take root within a few weeks in the bone marrow before you begin to create new blood cells. At this time, the patient is very vulnerable to infections, so it is necessary precautions to protect the body, until the level of white blood cell count is restored.

The patient will be in a special ward under the supervision of doctors, antibiotics may be prescribed to prevent infection. During this period, the clinic specialists provide special care to the patient.

The reaction of "graft versus host"

When allogeneic transplantation is a risk that the new cells (the graft) will react against the body's tissues. Doctors and nurses closely monitor the time of transplantation and for several months thereafter, whether there are any signs of this reaction. If they occur, it does not mean that the transplant procedure was unsuccessful. It may even be useful when some of the cells involved in the response, attack leukemia cells that managed to survive.

The patient is prescribed medication to prevent this side effect, or to make it less severe.

donor lymphocytes

After allogeneic transplantation doctors monitor the condition of the blood, the presence of leukemic cells. Sometimes it saves them a small amount. This may be one of the reasons for relapse of CML.

myeloid leukemia Treatment with lymphocytes may be one way to get rid of malignant cells. They were taken from the same donor as the stem cells. Lymphocytes help the immune system to cope with the disease. This procedure is known as "graft versus leukemia". They are administered intravenously, sometimes repeated 3 or 4 times. Sometimes infusion of lymphocytes can cause a reaction "graft versus host".

interferon alfa

Interferon alpha is a protein that is produced in the body during viral infections such as influenza. This drug is prescribed in chronic phase CML, when other treatments are not effective myeloid leukemia. It enters the body by injection.

Side effects of interferon-alpha are like the symptoms of flu and include chills, fever, depression, lose weight, headaches; aching pain in the back, joints and muscles; fatigue. Some of them are reduced by adopting light painkillers, such as paracetamol. The doctor will give further guidance on this issue. Undesirable effects are expressed during the first and the second injection, then erased, fatigue may persist.

Coordinating Center «Tlv.Hospital» will assist in the organization of the treatment of chronic myeloid leukemia in Israeli hospitals: in the selection of the clinic, the best specialists, domestic support.

Chemotherapy in the treatment of chronic mieloleyoza in Israel

Despite the fact that imatinib is the standard treatment for CML, chemotherapy is also sometimes used. It is used when imatinib and other tyrosine kinase inhibitors are not effective or cause serious side effects.

When the diagnosis of some patients prescribed hydroxyurea (Hydroxycarbamide) tablets at a time, while awaiting the results of analyzes of the type of chronic mieloleyoza. In most cases, then prescribed imatinib.

Typically, chemotherapy drugs are taken orally and caused mild side effects. Sometimes the need for more intensive chemotherapy, suggesting intravenous administration. It is usually carried out on the terminal phase, it provokes more serious unwanted effects.

Patients who suggest treated with stem cell transplantation, chemotherapy is prescribed as a preparation.

Chemotherapy tablets

In the treatment of CML in the chronic phase of cytostatic agents are usually given orally. The most common of them - hydroxycarbamide. Taken daily, the dose depends on the results of blood tests.

If the number of white blood cells falls below a certain level, the treatment of myeloid leukemia may be suspended. Side effects are usually quite soft.

combinations of chemotherapy

If CML symptoms begin to resemble the signs of acute myeloid leukemia, conduct high-intensity chemotherapy with stem cell transplantation. The combination is composed of 3 or 4 drugs are administered intravenously.

A doctor in the Israeli clinic will provide more information about medicines and their potential side effects.

Applied central catheter, PICC line system (implantable central venous catheter) for administration of cytostatics.

Possible side effects

  1. the risk of infection. Chemotherapy destroys leukemia cells, but, in addition, temporarily reduces the number of healthy blood cells. blood tests during the treatment of myeloid leukemia are held regularly. If the white blood cell count is too low, the patient is at high risk of infection, and chemotherapy may be delayed for some time, until he recovers.
  2. Anemia, bruising and bleeding are observed due to the reduction of platelets and red blood cells due to the impact of chemotherapy. Problems of blood clotting can cause bruising, various abnormal bleeding. To restore their levels are sometimes required a blood transfusion, which is carried out on an outpatient basis.
  3. Nausea. Some chemotherapy drugs cause nausea or vomiting. There are effective, affordable medicines that facilitate these conditions, they will appoint a physician if necessary.
  4. Inflammation in the mouth. Cytotoxic agents can provoke an inflammatory process in the mouth, the formation of small ulcers. The doctor prescribes a special mouthwashes. In the presence of this side effect is better to avoid drinking alcohol, very hot, salty and spicy food.
  5. Fatigue. If myeloid leukemia treatments include three or more cytostatic agents for an extended period of time, most likely the patient will feel very tired. In this case it is necessary to schedule rest periods every day. It would be useful to combine rest and light exercise when the patient will be able to do it.
  6. Hair loss caused by certain chemotherapy drugs. The appearance of this side effect depends on the treatment of chronic myeloid leukemia. The doctor will explain what to expect from treatment.
  7. Fertility. Certain cytotoxic agents can lead to infertility. Violation may be temporary or permanent, depending on the medication taken. If a patient plans to have children in the future, you should discuss this with your doctor before you start chemotherapy. He will be able to say whether fertility is affected, and what options may be available.