Treating Chronic Myeloid Leukaemia (CML)

CML is a disease of "firsts"^2,3

• The first neoplasia of white blood cells for which the term leukaemia was used with its discovery and description in 1845
• The first cancer to be associated with a specific abnormal chromosome, the Philadelphia chromosome, in 1960

Until the availability of imatinib, the treatment landscape for CML looked much like that for other cancers. Arsenic, splenectomy, and radiotherapy in the 19th and 20th centuries gave way to the alkylating agents busulfan and hydroxyurea. In the late 1990s recombinant interferon alpha, combined with hydroxyurea or cytarabine, became the treatment of choice. None of these therapies offered the promise of a cure. Allogeneic stem cell transplantation eventually emerged as an intervention that does offer the potential for cure in some. ^2,4

The elegant line of research that ensued once the link between CML and the Philadelphia chromosome was established opened the door to the possibility of a novel targeted way to treat CML. Imatinib was the first therapy to deliver on that promise. The role of tyrosine kinase inhibitors in the treatment of CML was affirmed in 2006 when an expert panel convened by the European Leukaemia Net reviewed the published literature and recommended imatinib as the treatment of choice for patients in early chronic phase CML. ^2,4