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KEY CONCEPTS

KEY CONCEPTS

  • image Chronic myeloid leukemia (CML) is defined by the presence of the Philadelphia chromosome (Ph), a translocation between chromosomes 9 and 22. The resulting abnormal fusion protein, p210 BCR-ABL, phosphorylates tyrosine kinase residues and is constitutively active, resulting in uncontrolled hematopoietic cell proliferation.

  • image Without treatment, the disease course of CML is characterized by a progressive increase in white blood cells over a period of years that ultimately transforms into acute leukemia.

  • image The commercially available tyrosine kinase inhibitors, imatinib, dasatinib, nilotinib, bosutinib, and ponatinib have demonstrated efficacy in the treatment of newly diagnosed CML patients and in patients with either accelerated phase or blast crisis.

  • image CML monitoring requires the assessment of milestones throughout the therapy such as hematologic, cytogenetic, and molecular responses, the ideal of which is a molecular response.

  • image Allogeneic hematopoietic stem cell transplant (HSCT) is the only known curative treatment option for CML and is reserved for patients with a suitable donor and progression after treatment with tyrosine kinase-based therapy.

  • image The management of chronic lymphocytic leukemia (CLL) is highly individualized and includes observation in patients with early-stage disease and treatment with targeted therapy, chemotherapy, biologic therapy, or both in patients with more advanced disease.

  • image Alemtuzumab, ofatumumab, obinutuzumab, and rituximab are monoclonal antibodies that are indicated for the treatment of CLL.

  • image Regimens such as fludarabine, cyclophosphamide, and rituximab are considered as first-line therapy for patients with CLL who are younger or have more aggressive disease.

  • image Novel agents such as ibrutinib, idelalisib, duvelisib, venetoclax, and acalabrutinib provide an orally administered option for the treatment of CLL. Ibrutinib is approved for treatment of previously untreated patients and for patients with relapsed disease who have received at least one prior therapy. Oral agents such as venetoclax and idelalisib in combination with monoclonal antibodies are now first-line treatment options in patients with comorbidities.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity—Chronic Myeloid Leukemia (CML)

Watch the video entitled “What is chronic myelogenous leukemia?” by the Khan Academy

This 10-minute video provides a brief overview of CML as well as how to identify its signs, symptoms, diagnosis, and basic treatment overview. This video is useful to enhance student understanding regarding COLLECT and ASSESS steps in the patient care process.

Preclass Engaged Learning Activity—Chronic Lymphocytic Leukemia (CLL)

Watch the video: “Chronic Lymphocytic Leukemia with Bruce D. Cheson, MD-Everything You Need to Know”. This 12-minute video by the Lymphoma Research Foundation briefly reviews CLL, diagnosis, and treatment options. This video is designed to aid in the student’s patient care process, particularly the COLLECT and ASSESS steps.

INTRODUCTION

The chronic leukemias include chronic myeloid leukemia (CML), chronic lymphocytic leukemia (CLL), hairy cell leukemia, and prolymphocytic leukemia. The typical clinical presentation of the chronic leukemias is an indolent course in contrast to patients with acute leukemia who will die of their disease within weeks to months if not treated. ...

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