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24. Chronic Myeloid Leukemia
Historical articles
Nowell PC, Hungerford DA.

A minute chromosome in human chronic granulocytic leukemia.
Science. 1960;132:1497.
Description: The first description of what would come to be known as the Philadelphia chromosome.

Daley GQ, Van Etten RA, Baltimore D.

Induction of chronic myelogenous leukemia in mice by the p210 BCR/ABL gene of the Philadelphia chromosome.
Science .1990;247:824-30.
Description: Demonstrated that BCR-ABL expression is sufficient for CML induction.
PubMed citation number: 2406902

Goldman JM, Apperley JF, Jones L, et al.

Bone marrow transplantation for patients with chronic myeloid leukemia.
N Engl J Med. 1986;314:202-207.
Description: Demonstrated that CML patients could achieve long-term remission and potentially cure with alloBMT
PubMed citation number: 3510388

Transplant & CML

Gratwohl A, Hermans J, Niederwieser D, et al.

Bone marrow transplantation for chronic myeloid leukemia: long-term results. Chronic Leukemia Working Party of the European Group for Bone Marrow Transplantation.
Bone Marrow Transplant. 1993;12:509-16.
Description: Registry data from the European Group for Bone Marrow Transplantation (EBMT) on over 1000 patients transplanted for different phases of CML. Reports that major prognostic factors are age, T cell depletion, time from diagnosis to transplant, WBC, and donor-recipient sex combination.
PubMed citation number: 8298562

Gale RP, Hehlmann R, Zhang M-J, et al.

Survival with bone marrow transplantation versus hydroxyurea or interferon for chronic myelogenous leukemia. The German CML Study Group.
Blood. 1998;91:1810-19.
Description: A registry study. This study reports higher early mortality, but better long-term survival with HLA-identical sibling transplants versus hydroxyurea or interferon in CML.
PubMed citation number: 9473250

Weisdorf DJ, Anasetti C, Antin JH, et al.

Allogeneic bone marrow transplantation for chronic myelogenous leukemia: comparative analysis of unrelated versus matched sibling donor transplantation.
Blood. 2002;99:1971-7.
Description: Prospective cohort study comparing matched unrelated donors to sibling donors. Reported that in young (<40y) patients with good risk CML, results with matched unrelated donors were similar to results with matched sibling donors.
PubMed citation number: 11877268

Donor lymphocyte infusions & CML

Dazzi F, Szydlo RM, Goldman JM.

Donor lymphocyte infusions for relapse of chronic myeloid leukemia after allogeneic stem cell transplant: where we now stand.
Exp Hematol. 1999;27:1477-86.
Description: Review of the molecular basis and use of DLI in patients with CML relapse following alloBMT.
PubMed citation number: 10517488

Interferon & CML

Baccarani M, Russo D, Rosti G and Marinelli G.

Interferon-alfa for chronic myeloid leukemia.
Semin Hematol. 2003;40:22-33.
Description: Succinct review of all of the major trials of IFN therapy in CML.
PubMed citation number: 12563609

Hasford J, Prirrmann M, Hehlmann R, et al.

A new prognostic score for survival of patients with chronic myeloid leukemia treated with interferon alfa.
J Natl Cancer Inst. 1998;90:850-58.
Description: A prognostic scoring system that estimates the survival of CML patients treated with IFN. It was developed and validated retrospectively through a meta-analysis.
PubMed citation number: 9625174

Gleevec & CML

O’Brien SG, Guilhot F, Larson RA et al.

Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia.
New Engl J Med. 2003;348:994-1004.
Description: The IRIS study. A RCT of imatinib vs. interferon + cytarabine for chronic-phase CML. Established that imatinib is superior to interferon with respect to efficacy and toxicity. This is the major trial supporting the use of imatinib as first line therapy for chronic-phase CML.
PubMed citation number: 12637609

Hughes TP, Kaeda J, Branford S, et al.

Frequency of major molecular responses to imatinib or interferon alfa plus cytarabine in newly diagnosed chronic myeloid leukemia.
New Engl J Med. 2003;349:1423-32.
Description: Demonstrated that in patients treated with imatinib or interferon + cytarabine, complete cytogenetic response and a > 3 log reduction in BCR-ABL transcripts by quantitative PCR were strongly correlated and that progression-free survival was 100% @ 24 months when both factors were present. However, also reported that very few patients (only 4%) achieved undetectable levels of BCR-ABL with either imatinib or IFN.
PubMed citation number: 14534335

O’Dwyer ME, Mauro MJ, Blasdel C, et al.

Clonal evolution and lack of cytogenetic response are adverse prognostic factors for hematologic relapse of chronic phase CML patients treated with imatinib mesylate.
Blood. 2004;103:451-5.
Description: Case series of patients with chronic-phase CML who failed IFN and were subsequently treated with imatinib. Reports that pre-treatment clonal evolution, pre-treatment elevated platelet count, and failure to achieve a major cytogenetic response at 6 months are all independently associated with hematologic relapse.
PubMed citation number: 14512312

General reviews

Melo JV, Hughes TP, Apperley JF.

Chronic myeloid leukemia.
Hematology (Am Soc Hematol Educ Program). 2003:132-52.
Description: Comprehensive review of the biology and management of CML in the post-imatinib era.
PubMed citation number: 14633780

Cortes J, Kantarjian H.

Advanced-phase chronic myeloid leukemia.
Semin Hematol. 2003;40:79-86.
Description: A recent review of the diagnosis, prognosis, and treatment of accelerated phase CML and blast crisis.
PubMed citation number: 12563614.

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