Best Rx for CML is:
1. Allogeneic or syngeneic bone marrow transplant: It is the best treatment & is a treatment of choice:
2. Imatinib is the drug of choiceQ : If no major cytogenic remission, try dasatinib or INF-alpha
3. Recent Advances: Newer drugs for resistant cases – Nilotinib, Dasatinib
c. Treatment of accelerated phase and blast crisis: Hydroxyurea is very useful in this stage. When blast transformation occurs, treatment is according to the type of blasts, i.e. whether the type is lymphoblastic or myeloblastic as already described.
6. Leukopheresis and Splenectomy Q
7. Arsenic Q
Imatinib is also used in GIST (AIIMS May 2008)
Recent Advances – New Drugs:
Sunitinib - GIST, RCC Sorafinib – RCC, Melanoma
Gefitinib - NSCC Bortezomib – Multiple myeloma
Erlotinib - Non small cell ca lung (NSCC), Pancreatitis
Extra Edge: (Ref. Hari-18th ed., Pg. 917, table 109.6)
1. Omacetaxine (also known as homoharringtonine) is a Protein translation inhibitor
2. Finglolimod: It controls activation of protein phosphatase 2A that is essential for ABL1-mediated leukemogenesis
3. Sorafenib: It is a Raf kinase inhibitor that down regulates down stream Bcr-Abl targets TK inhibitors.