Delayed achievement of cytogenetic and molecular response is associated with increased risk of progression among patients with chronic myeloid leukemia in early chronic phase receiving high-dose or standard-dose imatinib therapy.
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Dasatinib or high-dose imatinib for chronic-phase chronic myeloid leukemia resistant to imatinib at a dose of 400 to 600 milligrams daily: two-year follow-up of a randomized phase 2 study (START-R).
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Clinico-pathological features and outcomes in chronic phase chronic myeloid leukemia patients treated with hydroxyurea.
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OBJECTIVE: To study the clinico-pathological features and major outcomes in patients with chronic myeloid leukemia, chronic phase, treated with hydroxyurea. METHODS: This is a single centre study extending from January 1997 to June 2003. Data were retrieved from the patients' records on predetermined performance and analyzed. Patients were primarily diagnosed on the basis of clinical findings, complete blood counts and leukocyte alkaline phosphate (LAP) scores. Bone marrow/trephine and genetic studies were conducted where appropriate. Patients were primarily treated with capsule hydroxyurea 30-50/ kg/day. RESULTS: One hundred and seventy six patients, 104 (59%) male and 72 (41%) females were included in the study. The median age at diagnosis was 39 years (range 11 to 66 years). The median delay in diagnosis was 156 days (range 30 to 360 days). Eighty four patients (47.7%) presented with pain/discomfort in the left hypochondrium. The mean hemoglobin, white blood cell count and platelet counts were 10.3 g/dl, 141,000/UL and 341,000/UL respectively associated with a low LAP score. Hyper-leucocytosis was observed in 19 (10.7%) cases. LDH values above 1,000 ug/l were observed in 38 (21.5%) cases and creatinine above 1.5 ug/l in 21 (12%) cases. All patients tested, were positive for Philadelphia chromosome and bcr-abl transcripts. At the close of the study, disease advancement was observed in 76 (43.2%) cases, of which 35 (20%) transformed to acute leukemia. One hundred and forty three patients (81%) were alive at the close of the study. One hundred and two (58.4%) patients were in chronic phase, 22 (12.5%) in accelerated phase and 19 (10.7%) in blast crisis. Disease progression remained the major cause of death and was seen in 29 (16.4%) patients. CONCLUSION: In the study population, CML was observed in a younger age group with significant delay in definitive diagnosis. Clinico-pathological features and major outcomes, however, appear comparable to published data. (+info)
Dasatinib 100 mg once daily minimizes the occurrence of pleural effusion in patients with chronic myeloid leukemia in chronic phase and efficacy is unaffected in patients who develop pleural effusion.
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Differential diagnosis between chronic granulocytic leukemia, polycythaemia vera and essential thrombocythemia using micro-and ultrastructural measurement data performed at the level of megakaryocyte.
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The common features of chronic myeloproliferative disorders (CMDs) make the differential diagnosis on clinical or paraclinical basis to become more difficult, and validate the requirements for new methods of detailed diagnosis. Besides the cytogenetic methods, the megakaryocyte (MK) morphology is a valuable element of diagnosis included in the recent "en vogue" criteria. The purpose of this paper is to compare different morphological parameters in MKs from patients diagnosed with three CMDs and to establish a differential diagnosis of these disorders. Studies were performed on smears of bone marrow blood - for light microscope analysis -, and bone marrow biopsies - for transmission electron microscope (TEM) analysis - collected from six patients, two diagnosed with chronic granulocytic leukemia (CGL), two with polycythaemia vera (PV), and other two with essential thrombocythemia (ET). On the light microscope images, we observed important differences between the sizes of MKs and of MKs nuclei in CGL, PV, and ET. On the TEM images, we also noted important differences concerning the size and the aspect of nuclei, aspect of mitochondria, the amount and distribution of RER, Golgi apparatus and demarcation membrane system; the most important are the differences recorded in the number, distribution and sizes of vacuoles, alpha-granules and of the dense bodies. This study provides evidence that there are significant morphological differences between the cellular structures in the MKs from the patients with diagnosed with different CMDs, and thus sustains the utilization of this approach for establishing the differential diagnosis of CMDs. (+info)