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Imatinib combined with mitoxantrone/etoposide and cytarabine is an effective induction therapy for patients with chronic myeloid leukemia in myeloid blast crisis.
The clinical and morphologic features at the outset did not fit a diagnosis of CML, chronic phase, accelerated phase, or blast crisis, as defined by the World Health Organization blue book (1).
The approval of Gleevec(x) is based on data from three Phase II open- label, single arm studies that showed a major cytogenetic response in patients with advanced stages of CML (21 per cent in the accelerated phase and 14 per cent in myeloid blast crisis), as well as hematologic responses for patients in accelerated phase and myeloid blast crisis (63 per cent and 26 per cent, respectively).
Responses occurred in 55 percent of those with myeloid blast crisis, with four of those patients having their white blood cell counts returned to normal.
Morphologic and immunological features of blasts in blast crisis may be discordant.
Results showed that fewer patients progressed to accelerated phase or blast crisis on Tasigna at 300 mg twice daily (n = 2) and 400 mg twice daily (n = 1) versus Glivec at 400 mg once daily (n = 12) with 18 months of median follow-up, demonstrating a significant improvement in disease control.
3,4) This case represents an example of simultaneous extramedullary and intramedullary CML blast crisis following transplant.
1) Though the skin infiltrate show less than 5% blast and reported in chronic phase of the disease, presence of leukemia cutis strongly suggests that blast crisis is imminent.
Imatinib was approved by the Food and Drug Administration in February 2002 for the treatment of patients with CML in blast crisis, accelerated phase, or in chronic phase after failing to respond to interferon.
5% of Gleevec patients progressed to the accelerated phase or blast crisis, compared with 7% of interferon patients.