Chronic myeloid leukemia (CML) treatment in 720 Oncology clinics worldwide

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720 clinics specializing in Oncology providing treatment of Chronic myeloid leukemia (CML) Chronic myeloid leukemia (CML) is a type of cancer that affects the bone marrow, leading to the overproduction of abnormal white blood cells. Treatment may involve targeted therapy with tyrosine kinase inhibitors or stem cell transplantation for managing the disease.
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disease worldwide.

Africa · 11
Americas · 161
Asia · 225
Europe · 289
Oceania · 34
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Africa · 11 Americas · 161 Asia · 225 Europe · 289 Oceania · 34
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Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Chemotherapy for leukemia
    by request
  4. Cord blood stem cell transplantation
    by request
  5. Hemicolectomy
    ≈ $3,299
  6. Rectum anterior resection
    ≈ $3,163
  7. Radical prostatectomy
    ≈ $663
  8. Transurethral resection of the prostate (TURP)
    ≈ $2,142
  9. Conization
    ≈ $685
photo
Lajeado, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Orthopedic surgery, Oncology
Bruno Born Hospital is a philanthropic institution, with more than 80 years. It is registered with the National, State and Municipal Councils of Social Assistance read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Autologous bone marrow transplantation (BMT)
    by request
  4. Allogeneic bone marrow transplantation (BMT)
    by request
  5. Chemotherapy for leukemia
    by request
  6. Cord blood stem cell transplantation
    by request
  7. Hemicolectomy
    ≈ $3,299
  8. Rectum anterior resection
    ≈ $3,163
  9. Radical prostatectomy
    ≈ $663
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ Hospital São Camilo Pompeia has followed, over the years, the growth of the population and the scientific and technological advances aimed at medical and read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Autologous bone marrow transplantation (BMT)
    by request
  4. Allogeneic bone marrow transplantation (BMT)
    by request
  5. Chemotherapy for leukemia
    by request
  6. Cord blood stem cell transplantation
    by request
  7. Hemicolectomy
    ≈ $3,299
  8. Rectum anterior resection
    ≈ $3,163
  9. Radical prostatectomy
    ≈ $663
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
Integrated into the São Camilo de São Paulo Hospitals Network in March 1979, the Santana Unit has an agile and modern structure implemented to offer read more
Prices for popular procedures:
  1. Chemotherapy for leukemia
    by request
  2. Childhood vascular tumor treatment
    ≈ $472
  3. Thoracoplasty including sternoplasty
    ≈ $2,678
  4. Diagnostic thoracoscopy
    ≈ $1,132
  5. Carotid endarterectomy (CEA)
    ≈ $2,811
  6. Repair of diaphragmatic hernia
    ≈ $2,647
  7. Laminectomy
    ≈ $3,453
  8. Peripheral artery angioplasty and stent placement
    ≈ $2,800
  9. Abdominal endovascular aneurysm repair (EVAR)
    ≈ $9,078
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
A member of the Network since 2000, Hospital São Camilo Ipiranga has an emergency room for patients aged 12 years and over, an Intensive Care read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Autologous bone marrow transplantation (BMT)
    by request
  4. Allogeneic bone marrow transplantation (BMT)
    by request
  5. Chemotherapy for leukemia
    by request
  6. Cord blood stem cell transplantation
    by request
  7. Hemicolectomy
    ≈ $3,299
  8. Rectum anterior resection
    ≈ $3,163
  9. Radical prostatectomy
    ≈ $663
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
Founded in 1968, the Mooca unit is known for being a highly complex Oncological Treatment Center and for having a renowned Clinical Research Center. In read more
Prices for popular procedures:
  1. Autologous bone marrow transplantation (BMT)
    by request
  2. Allogeneic bone marrow transplantation (BMT)
    by request
  3. Chemotherapy for leukemia
    by request
  4. Hemicolectomy
    ≈ $3,299
  5. Rectum anterior resection
    ≈ $3,163
  6. Radical prostatectomy
    ≈ $663
  7. Transurethral resection of the prostate (TURP)
    ≈ $2,142
  8. Conization
    ≈ $685
  9. Open hysterectomy
    ≈ $2,011
photo
Rio de Janeiro, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Quinta D'Or Hospital opened in September 2001 and is located opposite Quinta da Boa Vista, in Rio de Janeiro. It emerged from the renovation read more
Prices for popular procedures:
  1. Targeted therapy
    by request
  2. Chemotherapy for leukemia
    by request
  3. Chemotherapy for melanoma
    by request
  4. Chemotherapy for endometrial cancer
    by request
  5. Chemotherapy for gallbladder cancer
    by request
  6. Chemotherapy for colorectal cancer
    by request
  7. Chemotherapy for bone cancer
    by request
  8. Chemotherapy for eye cancer
    by request
  9. Chemotherapy for myeloma
    by request
photo
Belo Horizonte, Brazil
Specializations: Oncology
Founded in 1999, Oncocentro was born with the purpose of offering an integral, welcoming and interdisciplinary service. Over the years, it has become a reference read more
Prices for popular procedures:
  1. Chemotherapy for leukemia
    by request
  2. Parotidectomy
    ≈ $1,315
  3. Cervical lymphadenectomy
    ≈ $1,989
  4. Total glossectomy
    ≈ $1,743
  5. Oral cancer surgery
    ≈ $3,609
  6. Hemiglossectomy
    ≈ $1,316
  7. Submandibular gland resection
    ≈ $941
  8. Lip resection
    ≈ $1,253
  9. Floor of mouth cancer resection
    ≈ $768
photo
Belo Horizonte, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Lifecenter Hospital stands out among the most sophisticated and renowned health institutions in Minas Gerais. Its activities cover urgent and emergency medical care, surgeries, read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Targeted therapy
    by request
  4. Chemotherapy for leukemia
    by request
  5. Cord blood stem cell transplantation
    by request
  6. Hemicolectomy
    ≈ $3,299
  7. Rectum anterior resection
    ≈ $3,163
  8. Radical prostatectomy
    ≈ $663
  9. Transurethral resection of the prostate (TURP)
    ≈ $2,142
photo
Salvador, Brazil
Specializations: Vascular surgery, Thoracic surgery, Neurosurgery, Oncology
Founded 30 years ago, the Oncology Nucleus of Bahia (NOB) joined the Oncoclínicas Group in 2014. The clinic offers comprehensive and individualized care to cancer read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Chemotherapy for leukemia
    by request
  4. Cord blood stem cell transplantation
    by request
  5. Hemicolectomy
    ≈ $9,870
  6. Rectum anterior resection
    ≈ $10,181
  7. Radical prostatectomy
    ≈ $8,690
  8. Transurethral resection of the prostate (TURP)
    ≈ $4,268
  9. Conization
    ≈ $1,992
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
We invite you to visit one of the largest health institutions in the country… A sanatorium with history, but looking to the future. The Doctor read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Autologous bone marrow transplantation (BMT)
    by request
  4. Allogeneic bone marrow transplantation (BMT)
    by request
  5. Chemotherapy for leukemia
    by request
  6. Cord blood stem cell transplantation
    by request
  7. Radical prostatectomy
    ≈ $8,690
  8. Transurethral resection of the prostate (TURP)
    ≈ $4,268
  9. Conization
    ≈ $1,992
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The British Hospital of Buenos Aires is a non-profit civil association that aims to provide the community with highly complex health care, train medical professionals read more
Prices for popular procedures:
  1. Chemotherapy for leukemia
    by request
  2. Hemicolectomy
    ≈ $3,299
  3. Rectum anterior resection
    ≈ $3,163
  4. Radical prostatectomy
    ≈ $663
  5. Transurethral resection of the prostate (TURP)
    ≈ $2,142
  6. Conization
    ≈ $685
  7. Open hysterectomy
    ≈ $2,011
  8. Radical nephrectomy
    ≈ $4,539
  9. Loop electrosurgical excision procedure (LEEP)
    ≈ $413
photo
Serra, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Orthopedic surgery, Oncology
Founded in 2001, Vitória Apart Hospital is a center of excellence in high complexity medicine in Espírito Santo, prepared to take care of people's health read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Autologous bone marrow transplantation (BMT)
    by request
  4. Allogeneic bone marrow transplantation (BMT)
    by request
  5. Chemotherapy for leukemia
    by request
  6. Cord blood stem cell transplantation
    by request
  7. Radical prostatectomy
    ≈ $8,690
  8. Transurethral resection of the prostate (TURP)
    ≈ $4,268
  9. Conization
    ≈ $1,992
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Hospital de Clínicas José de San Martín is the flagship teaching hospital in our country. Dependent on the University of Buenos Aires, read more
Prices for popular procedures:
  1. Chemotherapy for leukemia
    by request
  2. Orbital tumor temoval
    ≈ $17,525
  3. Childhood vascular tumor treatment
    ≈ $736
  4. Dual chamber pacemaker insertion
    ≈ $7,092
  5. Arteriovenous (AV) fistula surgery
    ≈ $2,082
  6. Endovascular thrombectomy
    ≈ $3,688
  7. Brain tumors surgery
    ≈ $10,256
  8. Hip osteotomy
    ≈ $4,667
  9. Arthroscopic meniscus repair
    ≈ $2,320
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Ricardo Gutiérrez Children's Hospital is a highly complex, tertiary, reference hospital for the entire country and neighboring countries. Since its creation, in 1875, it read more
Prices for popular procedures:
  1. Autologous bone marrow transplantation (BMT)
    by request
  2. Allogeneic bone marrow transplantation (BMT)
    by request
  3. Chemotherapy for leukemia
    by request
  4. Childhood vascular tumor treatment
    ≈ $736
  5. Coronary artery bypass graft (CABG)
    ≈ $18,185
  6. Laminectomy
    ≈ $8,485
  7. Peripheral artery angioplasty and stent placement
    ≈ $5,524
  8. Arteriovenous (AV) fistula surgery
    ≈ $2,082
  9. Endovascular thrombectomy
    ≈ $3,688
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Hospital "Prof. Dr. Juan P. Garrahan" is the pediatric center of reference in public health, free and highly complex in Argentina. Since its inauguration, read more
Prices for popular procedures:
  1. Chemotherapy for leukemia
    by request
  2. Heart valve replacement
    ≈ $25,993
  3. Heart valve repair
    ≈ $22,434
  4. Aortic valve replacement (AVR)
    ≈ $25,253
  5. Mitral valve replacement (MVR)
    ≈ $19,340
  6. Transcatheter aortic valve replacement (TAVR)
    ≈ $34,451
  7. Varicose veins treatment
    ≈ $4,587
  8. Brain aneurysm repair
    ≈ $11,974
  9. Brain aneurysm clipping
    ≈ $11,766
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Orthopedic surgery, Oncology
On July 24, 1896, the Pirovano Hospital (which was to be called Belgrano Hospital) opened its doors to ensure the assistance of an original population read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Chemotherapy for leukemia
    by request
  4. Cord blood stem cell transplantation
    by request
  5. Radical prostatectomy
    ≈ $8,690
  6. Transurethral resection of the prostate (TURP)
    ≈ $4,268
  7. Conization
    ≈ $1,992
  8. Open hysterectomy
    ≈ $3,654
  9. Radical nephrectomy
    ≈ $9,530
photo
Rosario, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
More than 100 years ago, on June 24, 1912, the Spanish Hospital was inaugurated in Rosario, driven by the demand for health care from Spanish read more
Prices for popular procedures:
  1. Chemotherapy for leukemia
    by request
  2. Radical prostatectomy
    ≈ $8,690
  3. Transurethral resection of the prostate (TURP)
    ≈ $4,268
  4. Conization
    ≈ $1,992
  5. Open hysterectomy
    ≈ $3,654
  6. Radical nephrectomy
    ≈ $9,530
  7. Loop electrosurgical excision procedure (LEEP)
    ≈ $1,079
  8. Total laparoscopic hysterectomy (TLH)
    ≈ $4,328
  9. Parotidectomy
    ≈ $2,818
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Pueyrredon Private Clinic was born in response to the need of Mar del Plata doctors who worked at that time as professionals in mutual read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Autologous bone marrow transplantation (BMT)
    by request
  4. Allogeneic bone marrow transplantation (BMT)
    by request
  5. Chemotherapy for leukemia
    by request
  6. Cord blood stem cell transplantation
    by request
  7. Radical prostatectomy
    ≈ $8,690
  8. Transurethral resection of the prostate (TURP)
    ≈ $4,268
  9. Conization
    ≈ $1,992
photo
Córdoba, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
We are a benchmark health care network in Argentina and we are committed to offering the world excellent medicine. Our Hospital is among the main read more
Prices for popular procedures:
  1. Targeted therapy
    by request
  2. Chemotherapy for leukemia
    by request
  3. Hemicolectomy
    ≈ $9,870
  4. Rectum anterior resection
    ≈ $10,181
  5. Radical prostatectomy
    ≈ $8,690
  6. Transurethral resection of the prostate (TURP)
    ≈ $4,268
  7. Conization
    ≈ $1,992
  8. Open hysterectomy
    ≈ $3,654
  9. Radical nephrectomy
    ≈ $9,530
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Thoracic surgery, Neurosurgery, Spine surgery, Oncology
The “Ángel H. Roffo” Institute of Oncology is a high-complexity referral center at the national level, dedicated to the multidisciplinary care of adult cancer patients. read more

Clinics grouping by rating

Clinic with the highest rating of 5 — Berkana clinic in Moscow, Russia and 2 more, clinic with the most reviews number of 35757 — Aster CMI hospital in Bengaluru, India.

With rating 4.0 and over — 238 clinics .

Countries with the highest number of clinics treating the diseases:

Chronic myeloid leukemia (CML):

Related procedures:

Chronic Myeloid Leukemia: Diagnostic and Treatment Options

Introduction & Classification of Chronic Myeloid Leukemia

Leukemia is a type of cancer of the blood. There are different forms of leukemia depending on what type of blood cell is affected. "Chronic" describes a gradual or slow progression, and "myeloid" denotes the origin of myeloid cells, immature cells that normally become mature red blood cells, white blood cells, or platelets. In chronic myeloid leukemia, the bone marrow produces too many myeloid blood cells, which are at various maturation stages, including cells known as immature granulocytes, metamyelocytes, and myeloblasts. Platelets and basophils (different myeloid cells responsible, in part, for the allergic response) are also often overproduced at diagnosis. Excess production of myeloid blood cells in the bone marrow ultimately prevents the normal production of red blood cells, essential in delivering oxygen to all cells in the body. It can also decrease the production of platelets or cause thrombocytopenia. Platelets play a critical role in stopping bleeding [ESMO, 2017].

The cause of chronic myeloid leukemia (CML) is known to result from a specific genetic abnormality that occurs in the blood stem cell. However, the exact cause leading to the cellular disbalance is not understood. The genetic abnormality is known as a translocation. For CML, specifically, genes from chromosome 9 are swapped with genes from chromosome 22. Translocation of the Abelson murine leukemia gene (ABL) on chromosome nine and the breakpoint cluster region (BCR) on chromosome 22, resulting in the Philadelphia chromosome [translocation of chromosomes 9 and 22, t(9;22)] can be detected in 95% of patients with CML either from cells circulating in the blood or the bone marrow.

The Philadelphia chromosome encodes a dysregulated tyrosine kinase (an enzyme in cells), which results in an abnormal behaviour of the cells affected. This includes the formation of immortalized cells, increased cell turnover and proliferation, and abnormal cell maturation.

Stages of CML

Unlike other cancers, which develop at a single site (such as breast cancer within the breast or prostate cancer within the prostate) and then spread (metastasize), malignant cells in patients with leukemia are considered to be present throughout the body at diagnosis due to their normal circulation in the bloodstream. For this reason, the prognosis is not determined by the extent of the spread of the disease. The stage of disease is determined by the "phase," including chronic, accelerated, and blastic phase or blast crisis. The majority of patients are diagnosed in the chronic phase. Patients are diagnosed with accelerated phase disease if the percentage of blasts increases to 15-29% in the blood or bone marrow, greater than 20% basophils develop in the blood, platelets either become severely elevated or low (but not as a result of therapy), or a clonal abnormality develops in addition to the Philadelphia chromosome. The most advanced stage of the disease is blast crisis, which is defined by an increase in bone marrow or peripheral blood blasts to at least 30%.

Algorithm of Diagnosis

What evaluations do CML patients undergo to identify the best treatment strategy?

Diagnosing CML involves a series of tests to confirm the disease, determine its stage, and identify the most appropriate treatment options [ashpublications.org].

  1. A thorough physical examination is performed to check for signs of lymphadenopathy (enlarged lymph nodes), hepatosplenomegaly (enlarged liver and spleen), and signs of anemia or thrombocytopenia.
  2. A complete blood count (CBC) and peripheral blood smear are essential to identify lymphocytosis and assess the overall health of blood cells. Flow cytometry is used to characterize the lymphocytes in a lab and confirm the diagnosis of CML by identifying specific cell surface markers (e.g., CD5, CD19, CD23, CD38).
  3. Although not always necessary for diagnosis, a bone marrow biopsy can help assess the extent of disease infiltration and the health of bone marrow function.
  4. Cytogenetic and Molecular Tests support the identification of genetic abnormalities that can influence prognosis and treatment decisions. Key genetic markers include:
    • FISH (Fluorescence In Situ Hybridization) detects common chromosomal abnormalities such as del(13q), del(11q), and trisomy 12.
    • PCR (Polymerase Chain Reaction) is used to identify specific mutations like TP53 and IGHV status.
    • Next-Generation Sequencing (NGS) provides a comprehensive analysis of genetic mutations and helps identify targets for personalized therapy.
  5. Imaging Studies: CT scans, or ultrasounds may be used to evaluate the extent of lymphadenopathy and organ involvement.

Phases of Treatment

How is CML treatment structured?

Treatment for CML is tailored to the individual's disease stage, symptoms, and overall health [hematology.org].

Treatment for chronic phase CML

All CML patients should first be treated with a targeted inhibitor of the mutated tyrosine kinase, also known as the BCR-ABL tyrosine kinase. Imatinib is a first-generation oral tyrosine kinase inhibitor (TKI) that achieves an 8-year overall survival of nearly 90% of patients. Second-generation tyrosine kinase inhibitors, such as dasatinib or nilotinib, may also be considered for all patients with CML upon diagnosis. More specific TKI include ibrutinib (acalabrutinib - as an alternative) for CML patients with del(17p) or TP53 mutations,

Other agents, including interferon and hydroxyurea, have a limited role in first-line therapy. Hydroxyurea is used to rapidly lower disease burden and white blood cell counts.

Response assessment is based on three levels of response: hematologic response, cytogenetic

response and molecular response, as described below:

1. Hematologic response:

- The peripheral WBC level and platelet count are monitored every two weeks after the initiation of therapy.

- A complete hematologic response (CHR) – meaning normalization of blood environment - is the association of

- a total WBC <10x10<sup>9</sup>/l,

- a WBC formula with no present immature granulocytes and <5% of basophils,

- platelets count <450x10<sup>9</sup>/l,

- and non-palpable spleen.

2. Cytogenetic response (CgR):

- Cytogenetics is monitored after three months, six months, 12 months, and 18 months of therapy with a TKI. Until a complete cytogenetic response (CCgR) is achieved, cytogenetics should be repeated at least every six months.

- A complete cytogenetic response (CCgR)is defined by the inability to detect the Philadelphia chromosome by analyzing the chromosomes metaphases in a lab.

- A partial cytogenetic response (PCgR) is defined as the presence of 1%–35% positive Philadelphia chromosome metaphases.

3. Molecular response

- Monitoring of molecular response is done with PCR, which quantifies the BCR-ABL/ ABL mutations.

- It should be repeated at least every three months until a significant molecular remission is achieved.

- Major molecular remission is defined by a PCR result with BCR-ABL/ABL <0.10% on the International Scale.

Once a complete cytogenetic response and a significant molecular remission have been achieved, cytogenetic monitoring should be performed every 12 months, and molecular tracking by PCR should be performed every six months.

Treatment for accelerated phase or blast crisis CML

Treatment with a tyrosine kinase inhibitor can be initiated in patients who have not already been treated with a tyrosine kinase inhibitor. Change to another tyrosine kinase inhibitor, or chemotherapy can be considered for patients already treated with a tyrosine kinase inhibitor. However, those options are effective for only a limited time. Allogeneic bone marrow transplant is the only established curative therapy for CML in either of these phases of disease.

Treatment of patients who cannot tolerate tyrosine kinase inhibitors

Patients who develop severe side effects from first-generation tyrosine kinase inhibitors, such as severe rash, severe edema (swelling of the legs), or fluid accumulation in the lungs, should be first treated with second-generation tyrosine kinase inhibitors. Most patients who cannot tolerate first-generation tyrosine kinase inhibitors can be successfully treated with second-generation tyrosine kinase inhibitors without side effects. The dose of second-generation tyrosine kinase inhibitors can be reduced without decreasing efficacy to reduce the risk of side effects. For patients who cannot tolerate three tyrosine kinase inhibitors, a new therapy, omacetaxine, was recently shown to be effective and tolerable. In rare cases, patients who cannot tolerate all tyrosine kinase inhibitors should be considered for a bone marrow transplant from a sibling or unrelated donor.

Prognosis and Survival Rates

What are the survival rates and factors affecting prognosis?

The prognosis for CML varies widely based on genetic factors, disease stage, and response to treatment. The overall five-year survival rate for CML is approximately 85%, but this can vary significantly:

  • In patients with favourable cytogenetics (e.g., del(13q) only), there is a more prolonged median survival, often exceeding ten years after the treatment ends.
  • Patients with high-risk cytogenetics (e.g., del(17p) or TP53 mutations) - shorter median survival, often 2-5 years without effective targeted therapy [cancer.org].

Untreated patients with chronic phase CML will progress to the accelerated phase in 3-5 years. Patients

diagnosed with accelerated phase have a median survival of 4 to 6 months without treatment. Survival is further limited if a blast crisis occurs, with a median survival among untreated patients of 2 to 4 months.

A patient's prognosis is best predicted by the patient's characteristics (including percentage of basophils as well as spleen size). Multiple scoring systems using patients and disease characteristics have been developed, which estimate the likelihood of response to therapy and survival. When using the most up-to-date EUTOS risk score, five-year, progression-free survival was significantly better in the low than in the high-risk group (90% vs. 82%), but overall survival was only slightly lower than that of the standard, healthy population [European Leukemia Net, 2024].

Follow-Up and Monitoring

How do you ensure continued health after treatment?

In CML patients, the follow-up recommendation includes physical examination and CBC every three months for five years and repeated bone marrow biopsy with PCR cytogenetic testing only in case of treatment failure or in case of unexplained thrombocytopenia every three to six months until the complete (normal) cytogenetic response is achieved with no T315I BCR-ABL mutation detected [American Journal of Hematology, 2022].

  • Alejandro Santos, M.D.
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