Welcome to the eighteenth part of a series on Hemato-oncology.
Question: Dr. Chiragbhai, thank you for explaining to us about diagnosis and treatment of Chronic Myeloid Leukemia. It was heartening to know that first targeted therapy Imatinib is widely available in India, including free of cost for poor patients. And that it is first line option for almost all patients with CML.
So, what about other options, are they completely out of picture?
Answer: Your question is very valid. Yes, Imatinib does seem like a dream drug. However, it has certain limitations. To explain relative role of different options, we need to understand the Tree shown below. This is my favorite part in explaining about CML to patients.
As you can see in diagram, tree is above the surface, originating from the roots. Tree is similar to high white blood cell count that we see obviously with a simple blood test. However, it grows from roots i.e. the genetic abnormality.
Cytogenetics by karyotyping detects 1 in 50 abnormal cells with genetic abnormality, FISH detects 1 in 500 cells, and PCR detects 1 in 100,000 to 10,00,000 cells.
Treatment goal is to clear the Tree and the Roots to the lowest level i.e. normal PCR result, so that it does not grow back.
In next part, we will see effectiveness of different treatment options in clearing Tree and Roots.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496
Diplomate American Board of Oncology and Hematology. Ahmedabad. firstname.lastname@example.org
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad. www.shyamhemoncclinic.com