Diagnosis and Treatment of Chronic Myeloid Leukemia

Annette J. Neylon and Stephen G. O'Brien

The diagnosis of chronic myeloid leukemia (CML) usually pre-senbuts few problems. In contrast, knowing how to counsel a newly diagnosed patient and planning therapeutic strategy presents many difficulties. Is the patient suitable for an allo-graft?; should "mini-grafting" be considered?; will they tolerate interferon (IFN)-alpha?; should imatinib (Glivec, Gleevec— formerly ST1571 or CGP57184) be used and can a supply be secured? Even if one is fully informed of current developments, the answers to these questions are not always clear as there have been very significant therapeutic innovations in CML in the past 2 to 3 years. In parallel with these developments has been the Internet information "explosion" that we have witnessed in recent times. The Internet has introduced a new dimension to therapeutic decision making for both patients and their doctors. Patients increasingly have strong views on how they should be treated, often fueled by the Internet, and this can introduce inappropriate pressure to adopt unproven treatments (see end of chapter for some useful Website addresses).

In this chapter, we will review some of the essentials of diagnosis, which will be mostly self-evident to practising hematolo-gists. The main focus will be on available treatment options, the results to date using these various options, and guidance on therapeutic strategy. However, if the reader will forgive a crude paraphrase, there are at least three things about which we can be sure: death, taxes, and that the options for the treatment of CML will change again in the next year.

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