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Managing CML: Dealing With Drug Resistance

Summary & Participants

The approval of Gleevec (imatinib) in 2001 changed the future for patients with chronic myeloid leukemia (CML). CML is now one of the most treatable forms of cancer. In some patients, however, their disease becomes resistant to the treatment. Listen to the story of how one patient, along with her oncologist, Dr. Hagop Kantarjian of the M.D. Anderson Cancer Center, managed her CML.

Medically Reviewed On: May 09, 2008

Webcast Transcript

ANNOUNCER: Chronic Myeloid Leukemia, or CML, is a cancer of the blood where the bone marrow produces large numbers of myeloid, or white blood cells. It's a slow-growing, or "chronic," cancer that may take years to progress. Early symptoms are few, and a diagnosis of CML often catches patients by surprise.

WILLARD LANGLEY: I had my own business and I took one of those big, fancy executive exams over at Methodist Hospital and was perfect, every category except one, and that was my white blood cells. They were 19,500.

HAGOP KANTARJIAN, MD: He had what we call chronic phase CML, so he was in the very early stages of the disease.

WILLARD LANGLEY: Dr. K told me, he said, "A lot of patients have 200,000 on the white count before it's caught." So I was caught early.

ANNOUNCER: Dr. Kantarjian started Willard on what was the best treatment at the time: two medications: interferon and ARA-C.

HAGOP KANTARJIAN, MD: But the results are generally modest, and this treatment is associated with significant side effects.

WILLARD LANGLEY: It's a mean drug. It was to me. It did good for a while.

ANNOUNCER: For two years, Willard toughed it out through daily injections, flu-like side effects, fevers, extreme fatigue and a 60-pound weight loss.

WILLARD LANGLEY: I wound up in the emergency room down here with it when it got so bad.

ANNOUNCER: What's more, his CML had become resistant to the interferon and ARA-C. But by 1999, researchers at MD Anderson and elsewhere were testing a new treatment for CML, a drug that would come to be called "Gleevec."

HAGOP KANTARJIAN, MD: So I think even though he was pretty disappointed that he wasn't responding well anymore to the interferon/ARA-C, we were looking forward to putting him on this new medication and seeing how he does with it.

WILLARD LANGLEY: Dr. Kantarjian kept telling me, he said, "Hey," he said, "we've got something coming that will help you."

HAGOP KANTARJIAN, MD: We were already testing the Gleevec, and we had some inclination that it was going to work well.

WILLARD LANGLEY: And so I went on it December the 16th, and I've been told that I was the 45th patient put on it here. And then in March or April, when I got the results of my bone marrow, I was pretty close to remission. I felt a lot better.

HAGOP KANTARJIAN, MD: Within three months from starting the treatment, we achieved a complete hematologic remission. And that lasted for about two years, so he had very effective control over his disease

ANNOUNCER: The first two years on Gleevec, Willard achieved a significant response. The leukemia was affecting fewer than one in 200 of his white blood cells, but then it came back. The number of Philadelphia-positive cells, a marker for CML, had increased to 50 percent.

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