Traitement de la leucémie myéloïde chronique en 2007

The introduction of Imatinib (Gleevec), tyrosine kinase inhibitor, has revolutionized the drug therapy of chronic myeloid leukemia over the last few years with rates of complete cytogenetic remission of more than 80 % in newly diagnosed patients. First line treatment is now Imatinib 400 mg daily. Response is monitored, hematologically, cytogenetically and molecularly (with RQ-PCR every 3 months). Failure, optimal and suboptimal responses have been defined by the expert panel of the European Leukemia Net. Despite of high rates of complete cytogenetic remission residual disease remains detectable in the majority of patients, suggesting that they have reservoir of leukemic stem cells from which relapse may occur. Most of the responses to Imatinib are stable but some patients become intolerant or resistant to Imatinib. Mutations of the kinase domain of BCR-ABL, that impair Imatinib binding have been described as the leading cause of resistance. Dasatinib and Nilotinib restore hematological and cytogenetical remission in most of the patients with acquired resistance or primary failure. New drugs are tested in patients resistant to Dasatinib and Nilotinib. Treatment of chronic myeloid leukemia in an example of targeted therapy which requires specialized professionals. Follow up and decisions have to be taken with the assistance of an experimented centre.