Page 211 - Essential Haematology

Chapter 14 Chronic myeloid leukaemia / 197

100

White cell count (x10 9 /L) 10 1

(a) 100 0 100
Philadelphia metaphases in bone marrow (%) 50 70

(minor response)

0
0
(major response)
(b) 0 25 0 (complete response) 0
100
BCR-ABL1 ratio (%) ABL1 0.1 1
10

0.01
0.001
0
3 6 9 12 24 36 48
(c) Time (months)

Figure 14.5 Example of the haematological and cytogenetic response in a patient with chronic myeloid
leukaemia who achieves complete remission with imatinib therapy. (a) The white cell count returns to normal
within days. (b) Karyotypic examination of the bone marrow reveals a gradual reduction in the number of
Philadelphia chromosomes over the fi rst year. (c) Polymerase chain reaction (PCR) analysis of the bone marrow
or blood shows a reduction in the number of BCR - ABL1 transcripts in comparision with the normal ABL1
transcript. BCR - ABL1 transcripts continue to be detected at a very low level but can become negative in some
patients. In this case analysis was performed on bone marrow for the fi rst 12 months and on peripheral blood
thereafter.

100

Per cent without event 60
80

Figure 14.6 Clinical outcome of patients 40
given imatinib therapy for treatment of
chronic myeloid leukaemia (CML) in 20 Survival:
Deaths associated with CML 94%
chronic phase. After 7 years only 6% of Deaths from all causes 86%
0
patients died due to CML and overall
0 12 24 36 48 60 72 84 96
survival is 86%. (From O ’ Brien S.G. et al.
Months since randomization
Blood 2008; 112 :76a, with permission.)