Bosutinib Therapy in Patients With Chronic Myeloid Leukemia: Practical Considerations for Management of Side Effects.

The past decade has witnessed great advances in the treatment of chronic myeloid leukemia (CML), brought about in large part by the development of BCR-ABL tyrosine kinase inhibitors (TKIs). Bosutinib joins the armamentarium of approved TKIs for the treatment of chronic phase (CP), accelerated phase (AP), and blast phase (BP) Philadelphia chromosome (Ph)-positive CML resistant to or intolerant of prior therapy. Bosutinib has an adverse-event (AE) profile distinct from that of other TKIs.

Measuring the symptom burden associated with the treatment of chronic myeloid leukemia.

We developed a module of the MD Anderson Symptom Inventory (MDASI) for patients with chronic myeloid leukemia (CML). To develop the MDASI-CML, we identified CML-specific symptoms from qualitative interviews with 35 patients. A list of candidate symptoms was reduced by a panel of patients, caregivers, and clinicians to the 13 core MDASI symptom items and 6 CML-specific items; these items were subsequently administered to 30 patients.

Identification of side effects associated with intolerance to BCR-ABL inhibitors in patients with chronic myeloid leukemia.

Clinical intolerance occurs when the toxicity of a medication outweighs its clinical benefit. Early recognition of clinical intolerance to BCR-ABL inhibitors used for chronic myeloid leukemia (CML) is important for maximizing patient benefit. In CML, most side effects associated with BCR-ABL inhibitor therapy are mild and easily managed, so recognizing, monitoring, and addressing serious side effects may ensure optimal outcome.

Understanding iron overload: screening, monitoring, and caring for patients with transfusion-dependent anemias.

Patients receiving recurring blood transfusions as supportive therapy to treat chronic anemias, such as myelodysplastic syndromes, thalassemia, and sickle-cell disease, are at risk of iron accumulation. The clinical consequences of iron overload are progressive liver damage, cardiac disease, and endocrine disorders, which can be fatal. Nurses have a vital role in the initial assessment and monitoring of patients undergoing transfusion therapy and their ongoing care.

Successful completion of pregnancy in a patient with chronic myeloid leukemia without active intervention: a case report and review of the literature.

The management of patients with chronic myeloid leukemia (CML) during pregnancy is a matter of continued debate. We present a 21-year-old woman in whom CML was diagnosed during early pregnancy. Because the patient was asymptomatic and desired to carry the pregnancy to term while minimizing fetal exposure to medication, she was observed with no therapy for the duration of her pregnancy.

Pregnancy in a patient with hypereosinophilic syndrome.

Hypereosinophilic syndrome (HES) is a rare entity of unknown etiology that may cause a multitude of problems, from skin rash to organ failure, due to eosinophil infiltrate of tissues. Information on the interaction of hypereosinophilia and pregnancy in patients with established HES is very limited. Here we report a case of a woman with a seven year history of HES whose pregnancy resulted in the delivery of a healthy infant without complications, and no evidence of elevated eosinophils in the infants blood.

The effects of imatinib on pregnancy outcome.

Imatinib has now been in use for almost 10 years. Despite this cumulative experience, little is known about its effects on pregnancy; as a result, there are few published data to facilitate the counseling of women who conceive while taking imatinib. The results we now present provide information which may be of use in such circumstances.

Systemic mastocytosis in association with chronic lymphocytic leukemia: a rare diagnosis.

Systemic mastocytosis may be primary or be associated with other hematological malignancies, most commonly myeloid neoplasms. In contrast, the association of systemic mastocytosis with lymphoid neoplasms is comparatively rare, and in the absence of appropriate clinical vigilance the diagnosis may be missed. We report a case of aggressive systemic mastocytosis associated with chronic lymphocytic leukemia (SM-CLL), placing particular emphasis on the investigational algorithm used in establishing this diagnosis, and discussing key clinical considerations in the initiation of therapy.

Overview of second-generation tyrosine kinase inhibitors for patients with imatinib-resistant chronic myelogenous leukemia.

Imatinib mesylate (Gleevec, Novartis Pharmaceuticals Corporation, East Hanover, NJ) has revolutionized the treatment of chronic myelogenous leukemia (CML) with marked improvement in survival in all three phases--chronic, accelerated, and blast. Most patients with CML now receive imatinib, which produces complete cytogenetic response in more than 80% of patients. About 10% of patients who initially respond to imatinib subsequently develop resistance.

Pregnancy among patients with chronic myeloid leukemia treated with imatinib.

Purpose: Imatinib has potential teratogenicity in animals, but the effect of exposure to imatinib during conception and pregnancy in humans is not known.

Patients And Methods: The records of all patients with chronic myeloid leukemia (CML) treated with imatinib were reviewed. We report the experience on 19 pregnancies involving 18 patients (10 females and eight males) who conceived while receiving imatinib for the treatment of CML.

Interleukin 11 May improve thrombocytopenia associated with imatinib mesylate therapy in chronic Myelogenous leukemia.

During therapy with imatinib (Gleevec), 20-30% of patients with CML in chronic phase develop grade > or =3 thrombocytopenia. This leads to treatment interruptions and dose reductions that result in a decreased probability of achieving a cytogenetic response. Interleukin-11 (oprelvekin) is a megakaryopoietic cytokine that reduces the incidence and severity of thrombocytopenia associated with chemotherapy.

Management of molecular-targeted therapy for chronic myelogenous leukemia.

Purpose: To provide primary care providers with guidelines on the evaluation and management of treatment for patients with chronic myelogenous leukemia (CML) with emphasis on the molecular-targeted therapy imatinib mesylate.

Data Sources: Research-based articles in the medical literature, review articles, and clinical practice guidelines.

Conclusions: CML is a clonal stem cell disorder causing 5,000 new cases annually.

Efficacy of imatinib mesylate in the treatment of idiopathic hypereosinophilic syndrome.

Idiopathic hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterized by persistent eosinophilia and organ involvement. Different treatments have been investigated in HES with modest success. It has been suggested that imatinib is active in HES.

Response of idiopathic hypereosinophilic syndrome to treatment with imatinib mesylate.

Idiopathic hypereosinophilic syndrome (HES) is a rare hematologic disorder characterized by persistent eosinophilia with organ involvement. Patients with HES have a poor prognosis, but the disease course can be heterogeneous. Treatment of HES has included corticosteroids, chemotherapeutic agents such as cyclophosphamide, vincristine, hydroxyrea, and most recently interferon-alpha (IFN-alpha) which has shown long-term beneficial effects.