Grand Rounds

A Case Study Approach to Chronic Myelogenous Leukemia

Amy Goodrich, MSN, CRNP-AC

From the Johns Hopkins School of Medicine, Kimmel Cancer Center, Baltimore, MD.

The author has no conflicts to disclose.

Correspondence to: Amy Goodrich, MSN, CRNP-AC, Johns Hopkins School of Medicine, Kimmel Cancer Center, 550 North Broadway, Suite 1003 Baltimore, MD 21205. E-mail: goodram@jhmi.edu


J Adv Pract Oncol 2010;1:171–181 | DOI: 10.6004/jadpro.2010.1.3.3 | © 2010 Harborside Press


  

ABSTRACT

Chronic myelogenous leukemia (CML) is a bone marrow disorder characterized by the translocation of chromosomes 9 and 22. CML typically progresses through three stages: chronic phase, accelerated phase, and blast phase or blast crisis. Treatment options and prognosis for patients with newly diagnosed CML have improved dramatically in the past decade. Today, with first- and second-generation tyrosine kinase inhibitors (TKIs) available, the goal of therapy is 100% survival and a normal quality of life. Currently, there are three TKIs approved by the US Food and Drug Administration for patients with CML: imatinib, dasatinib, and nilotinib. Imatinib is approved for use as first-line therapy in patients with newly diagnosed CML. Nilotinib was recently approved for use as first-line therapy; along with dasatinib, it is also approved for use in patients with imatinib-resistant CML or in those patients who are intolerant of imatinib. Oncology advanced practitioners must understand these agents and their side effects to properly educate patients and their support systems, identify side effects early, intervene promptly, and minimize significant toxicity.


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