4.5 Review

Understanding and Monitoring Chronic Myeloid Leukemia Blast Crisis: How to Better Manage Patients

Journal

CANCER MANAGEMENT AND RESEARCH
Volume 13, Issue -, Pages 4987-5000

Publisher

DOVE MEDICAL PRESS LTD
DOI: 10.2147/CMAR.S314343

Keywords

chronic myeloid leukemia; blast crisis; mechanism; monitor; management

Categories

Funding

  1. Natural Science Foundation of China [81900152]
  2. Natural Science Foundation of Zhejiang Province [LQ19H080005, LY19H080005]
  3. Health Department of Zhejiang Province [2020KY113]

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CML is primarily caused by the t(9;22) translocation, resulting in the BCR-ABL fusion gene. Molecular mechanisms such as genetic aberrations, telomere biology, and epigenetic anomalies contribute to blast transformation of CML. Treatment options and outcomes are limited, with regular monitoring and risk-adapted therapeutic strategies being crucial in improving patient survival and quality of life.
Chronic myeloid leukemia (CML) is triggered primarily by the t(9;22) (q34.13; q11.23) translocation. This reciprocal chromosomal translocation leads to the formation of the BCR-ABL fusion gene. Patients in the chronic phase (CP) experience a good curative effect with tyrosine kinase inhibitors. However, cases are treatment refractory, with a dismal prognosis, when the disease has progressed to the accelerated phase (AP) or blast phase (BP). Until now, few reports have provided a comprehensive description of the mechanisms involved at different molecular levels. Indeed, the underlying pathogenesis of CML evolution comprises genetic aberrations, chromosomal translocations (except for the Philadelphia chromosome), telomere biology, and epigenetic anomalies. Herein, we provide knowledge of the biology responsible for blast transformation of CML at several levels, such as genetics, telomere biology, and epigenetic anomalies. Because of the limited treatment options available and poor outcomes, only the therapeutic response is monitored regularly, which involves BCR-ABL transcript level assessment and immunologic surveillance, with the optimal treatment strategy for patients in CP adapted to evaluate disease recurrence or progression. Overall, selecting optimal treatment endpoints to predict survival and successful TFR improves the quality of life of patients. Thus, identifying risk factors and developing risk-adapted therapeutic options may contribute to a better outcome for advanced-phase patients.

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