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Haznedaroğlu IC. Current management of chronic myeloid leukemia with tyrosine kinase inhibitors. Turk J Haematol 2013; 30:247-55. [PMID: 24385803 PMCID: PMC3878539 DOI: 10.4274/tjh.2013.0108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 04/02/2013] [Indexed: 12/01/2022] Open
Abstract
The clinical outcomes and survival of tyrosine kinase inhibitor (TKI)-treated patients with chronic myeloid leukemia (CML) have been significantly improved. The aim of this editorial is to outline critical steps of TKI administration practices during the long-term clinical course of CML based on data obtained from randomized clinical trials and international recommendations. The efficacy of TKI treatment, TKI side effects, off-target complications, and long-term morbidities due to both the disease and the drug are common arguments in the management of CML. Complete hematological response, early complete cytogenetic response, faster major molecular response, and deeper, more durable molecular responses (MR4, MR4.5, MR5) are the ultimate goals for TKI-receiving patients with CML. Conflict of interest:None declared.
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Allografting for Bosutinib, Imatinib, Nilotinib, Dasatinib, and Interferon Resistant Chronic Myeloid Leukemia without ABL Kinase Mutation. Case Rep Hematol 2011; 2011:263725. [PMID: 22937303 PMCID: PMC3420724 DOI: 10.1155/2011/263725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 09/18/2011] [Indexed: 11/18/2022] Open
Abstract
The current treatment of chronic phase chronic myeloid leukemia (CML) consists of oral tyrosine kinase inhibitors (TKIs). However, high-risk CML may present with an aggressive course which may result in blastic crisis or a "difficult-to-manage" state with available treatments. The aim of this paper is to report a patient with complicated CML resistant to treatment and progressed despite the administration of bosutinib, imatinib mesylate, nilotinib, dasatinib, interferon alpha 2a, cytotoxic chemotherapy, and allogeneic hematopoietic stem cell transplantation. The striking point of this case story is that no Abl kinase domain mutation against TKIs has been detected during this very complicated disease course of CML. Meanwhile, challenging cases will always be present despite the hope and progress in CML in the TKI era.
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Sayitoglu M, Haznedaroğlu IC, Hatirnaz O, Erbilgin Y, Aksu S, Koca E, Adiguzel C, Bayik M, Akalin I, Gülbas Z, Akay M, Unal A, Kaynar L, Ovali E, Yilmaz M, Yenerel M, Dagdas S, Ozet G, Ar C, Aydin Y, Soysal T, Durgun B, Ozcebe O, Tukun A, Ilhan O, Ozbek U. Effects of Imatinib Mesylate on Renin–Angiotensin System (RAS) Activity during the Clinical Course of Chronic Myeloid Leukaemia. J Int Med Res 2009; 37:1018-28. [DOI: 10.1177/147323000903700406] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The renin–angiotensin system (RAS) is involved in cell growth, proliferation and differentiation in bone marrow in an autocrine–paracrine manner, and it modulates normal and neoplastic haematopoietic cell proliferation. This study aimed to assess expressions of the RAS components, renin, angiotensinogen and angiotensin-converting enzyme (ACE), during imatinib mesylate treatment of patients with chronic myeloid leukaemia (CML). Expressions of RAS components were studied in patients with CML at the time of diagnosis ( n = 83) and at 3, 6 and 12 months after diagnosis ( n = 35) by quantitative real-time polymerase chain reaction. De novo CML patients had increased ACE, angiotensinogen and renin mRNA levels and these expression levels decreased following administration of imatinib. The RAS activities were significantly different among Sokal risk groups of CML, highlighting the altered biological activity of RAS in neoplastic disorders. The results of this study confirm that haematopoietic RAS affects neoplastic cell production, which may be altered via administration of tyrosine kinase inhibitors such as imatinib mesylate.
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Affiliation(s)
- M Sayitoglu
- Department of Genetics, Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - IC Haznedaroğlu
- Department of Internal Medicine, Haematology Division, Hacettepe University Medical Faculty, Ankara, Turkey
| | - O Hatirnaz
- Department of Genetics, Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Y Erbilgin
- Department of Genetics, Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - S Aksu
- Department of Internal Medicine, Haematology Division, Hacettepe University Medical Faculty, Ankara, Turkey
| | - E Koca
- Department of Internal Medicine, Haematology Division, Hacettepe University Medical Faculty, Ankara, Turkey
| | - C Adiguzel
- Department of Internal Medicine, Haematology Division, Marmara University Medical Faculty, Istanbul, Turkey
| | - M Bayik
- Department of Internal Medicine, Haematology Division, Marmara School of Medicine Hospital, Istanbul, Turkey
| | - I Akalin
- Department of Internal Medicine, Haematology Division, Marmara University Medical Faculty, Istanbul, Turkey
| | | | | | - A Unal
- Department of Internal Medicine, Haematology Division, Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - L Kaynar
- Department of Internal Medicine, Haematology Division, Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - E Ovali
- Department of Internal Medicine, Haematology Division, Erciyes University Medical Faculty, Kayseri, Turkey
| | - M Yilmaz
- Department of Internal Medicine, Haematology Division, Erciyes University Medical Faculty, Kayseri, Turkey
| | - M Yenerel
- Department of Internal Medicine, Haematology Division, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - S Dagdas
- Department of Internal Medicine, Haematology Division, Istanbul University Medical Faculty, Istanbul, Turkey
| | - G Ozet
- Department of Internal Medicine, Haematology Division, Istanbul University Medical Faculty, Istanbul, Turkey
| | - C Ar
- Department of Internal Medicine, Haematology Division, Ankara Numune Hospital, Ankara, Turkey
| | - Y Aydin
- Department of Internal Medicine, Haematology Division, Ankara Numune Hospital, Ankara, Turkey
| | - T Soysal
- Department of Internal Medicine, Haematology Division, Ankara Numune Hospital, Ankara, Turkey
| | - B Durgun
- Department of Internal Medicine, Haematology Division, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - O Ozcebe
- Department of Internal Medicine, Haematology Division, Hacettepe University Medical Faculty, Ankara, Turkey
| | - A Tukun
- Medical Department, Novartis Oncology Turkey, Istanbul, Turkey
| | - O Ilhan
- Department of Internal Medicine, Genetics Division, Ankara University Medical Faculty, Ankara, Turkey
| | - U Ozbek
- Department of Genetics, Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey
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