Due to the high efficacy of BCR-ABL tyrosine kinase inhibition (TKI) in chronic phase (CP) chronic myeloid leukemia (CML), the frequency of blast crisis (BC) is greatly reduced compared to the pre-TKI era. However, TKI treatment of BC has only marginally improved the number of favorable responses, including remissions, which for the most part have only been transitory. Occasionally, they provide a therapeutic window to perform an allogeneic stem cell transplantation (allo-SCT). The challenge remains to improve management of BC with the limited options available. We review and summarize articles pertaining to the treatment of BC CML published after 2002. Additionally, we will discuss whether there is a need for a new definition of BC and/or treatment failure.

Management of chronic myeloid leukemia in blast crisis.

Blast crisis (BC) is the sword of Damocles hanging over every patient with chronic myeloid leukemia (CML). In the past, CML virtually always progressed to BC. Conventional treatment of BC has been notoriously unsatisfactory resulting in only transient response and prolonging survival only marginally

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Treatment of chronic myeloid leukemia in blast crisis

.Suaheranc¸ageneticafoicomprovadaem2011.Lindhurstetal.realizaram o sequenciamento genetico de 29 pacientes com asindrome,sendoencontradaumamutac¸aosomaticanoonco-gene AKT1 e comprovado o mosaicismo somatico para umamutac¸ao, que e letal no estado nao mosaico. Foi comprovado,ainda, que a disfunc¸ao na via PI3K-AKT esta relacionada aocrescimento excessivo

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Associação médica brasileira

Background Tyrosine-kinase inhibitors (TKIs) can be associated with vascular events (VEs). The expected VE rates in patients with chronic myeloid leukemia (CML) are unknown. The present study examined the event rates and mortality among elderly patients with and without CML. Materials and Methods Linked Surveillance, Epidemiology, and End Results cancer registry and Medicare claims data were used to identify patients aged ≥ 66 years with an incident (index) diagnosis of CML from 2004 to 2009. A comparison cohort of patients without cancer was matched 1:1 to the CML cohort. All patients were followed up from 12 months before the index diagnosis through death or December 31, 2010. The overall survival and rates of myocardial infarction (MI), stroke, pulmonary embolism (PE), and peripheral arterial disease (PAD) were analyzed. Results A total of 1466 patients with CML (mean age, 78 years; average follow-up period, 25 months) were identified and matched 1:1 to a noncancer cohort (mean age, 78 years; follow-up period, 42 months). Compared with the noncancer patients, those with CML had greater mortality (63% vs. 23% died during the follow-up period; median survival, 23 vs. > 84 months) and greater rates of MI (33.0 vs. 11.9 per 1000 person-years), stroke (83.2 vs. 43.0), PE (6.6 vs. 2.6), and PAD (92.1 vs. 59.3; P Conclusion Elderly patients with CML had greater mortality and greater rates of MI, stroke, PE, and PAD than did noncancer patients. The event rates were not elevated among the TKI-treated (primary imatinib) patients, suggesting that the VE risk in these patients with CML was driven primarily by the underlying factors associated with CML.

https://www.clinical-lymphoma-myeloma-leukemia.com/article/S2152-2650(16)00052-5/pdf

Mortality and Vascular Events Among Elderly Patients With Chronic Myeloid Leukemia: A Retrospective Analysis of Linked SEER-Medicare Data.

The aim of this study was to identify publications in literature that investigated Homocysteine (He) as a risk factor for CVD among children and adolescents. An active search for information in LILACS, IBECS, Science Direct, Medline and Cochrane Library databases was conducted using the following combination of keywords "homocysteine", "cardiovascular diseases", "child" and "adolescent". Fifteen articles were analyzed showing direct relationship with increasing age (8 studies) and male gender (10 studies), and an inverse relationship with serum vitamins B6, B12 and folate levels. Thus, the results suggest that more research must be carried through in order to determine in a more coherent way the causes of the hiperhomocisteinemia in the pediatric population, guiding for an adequate diet, rich in nutrients necessary to favor the metabolism of the He.

Homocysteine: cardiovascular risk factor in children and adolescents?

Objective To determine the frequency of three phases of chronic myeloid leukaemia at first presentation. Study design Case series. Place and duration of study Department of Oncology, Combined Military Hospital (CMH), Rawalpindi, from June 2006 to December 2007. Methodology Forty-five patients of either gender with Chronic Myeloid Leukaemia (CML) at their first presentation in outpatient department were included in the study by consecutive sampling technique. All patients were diagnosed on blood complete picture and bone marrow examination including aspiration, trephine and cytogenetics at Armed Forces Institute of Pathology (AFIP). Each phase was defined on the basis of World Health Organization (WHO) criteria. Results Out of 45, there were 31 (68.9%) male and 14 (31.1%) female patients. The mean age of presentation was 37.9 years. The pattern of presentation revealed 35 (77.8%) in Chronic Phase (CP), 7 (15.5%) in Accelerated Phase (AP) and 3 (6.7%) in Blast Crisis (BC). Philadelphia chromosome was detected in 39 (86.7%) cases on culture method. Splenomegaly was observed in 37 (82.2%) patients. The mean total leukocyte count, platelet count, haemoglobin and marrow blast were 214.3 x 10(9)/L, 551.4 x 10(9)/L, 9.94 g/dl and 9.3% respectively. Conclusion CML presented at a younger age in the chronic phase.

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Presentating phases of chronic myeloid leukaemia.

OBJECTIVE To determine the frequency of bone marrow involvement in patients of Hodgkin's lymphoma on first presentation at oncology department. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY The Oncology Department, Combined Military Hospital, Rawalpindi, from April 2006 to February 2007. METHODOLOGY Thirty five patients of Hodgkin's lymphoma diagnosed on lymph node biopsy presenting for the first time at Oncology Department, Combined Military Hospital, Rawalpindi were included. They were admitted in the ward and evaluated with history, physical examination and staging investigations. Bone marrow trephine biopsy was performed in all patients. Descriptive statistics were used to analyze data. RESULTS On clinical and radiological evaluation, 8 patients (22.9%) had clinical stage (CS), 12 (34.3%) had CS II, 9 (25.7%) had CS III and 6 (17.1%) had CS IV. The microscopic appearance in bone marrow trephine examination showed lymphoma infiltrates in 6 (17.14%) patients and chronic disorder in 29 (82.85%) patients. Among patients with bone marrow infiltration, one had CS II disease, three had CS III disease and two had CS IV disease. One patient had bone marrow infiltration as the only manifestation of disease. CONCLUSION Bone marrow involvement was seen in patients with Hodgkin's lymphoma clinical stage II or higher.

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Riaz Ahmed

Papers

Presentating phases of chronic myeloid leukaemia.

Frequency of bone marrow involvement in Hodgkin's lymphoma on first presentation.