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Giris Yapin
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(since 07.Dec.2011)
Aim of the CML Treatment
CML Treatment
Side Effects of CML Treatment
Stem Cell Transfusion
Imatinib
Dasatinib
Nilotinib

Aim of the CML Treatment

  • Normalizing blood cell levels and eliminating Bcr-Abl gene cells in chronic phase CML.
  • If in the accelerated or blast phase, eliminating Bcr-Abl gene cells and reverting the disease back to chronic phase.

Consulting to a clinic with seasoned physicians is crucial for the continuity of the treatment in CLM treatment.

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CML Treatment

Treating CML in chronic phase usually reverts blood cells to a normal level. Spleen is in regular size. No infections or extraordinary bleedings are encountered in patients.

The treatment usually starts with a drug named Gleevec in which the active substance is Imanitib. This FDA approved drug is in use since 2001. As long as Imanitib is taken, the disease is contained in chronic phase. For patients not responding to usual doses an increase in dosage may be necessary.

Imanitib might not be of use for all CML patients. In certain cases Imanitib should be replaced with another drug.

  • When Imanitib fails to control the disease. (Drug resistance)
  • When Imanitib causes severe side effects. (Drug intolerance)
  • When Imanitib is totally useless. (Lack of response)

Patients with intolerance or resistance against Imanitib could use two other FDA approved drugs with active substances Dasatinib and Nilotinib.

Dasatinib is approved for all patients with resistance or intolerance against Imanitib. Where Nilotinib is for patients in the chronic or accelerated phases with resistance to other treatments including Imanitib.

All these three drugs are used orally.

Lots of CML patients receiving treatment during the chronic phase can go on with their daily businesses. With drug treatment it is possible to go a long period without symptoms or indications. This period is called the remission. However this does not mean the patient is cured. Patients in this phase should have their tests done regularly in order to see whether a symptom resurfaces. In certain intervals the lab tests should be renewed. Bone marrow aspiration and biopsy should be done in regular intervals.

The aim in the accelerated phase is eliminating Bcr-Abl genes and forcing the disease revert back to chronic phase. For patients suffering from blast seizures Imanitib and in some case Dasatinib or Nilotinib could be used. Interpheron, Busulfan, Sitarabin, Hydroxyurea are other choices.

During the diagnosis some patients may show very high levels of white sphere counts thus decreasing the amount of blood flowing to brain, lungs and eyes. Hydroxyurea is not used for diminishing white spheres. Then it’s possible to start oral medicine.

Leukopheresis is decreasing the white sphere count with a special device for patients with high white sphere counts during the diagnosis. This method is also used for first trimester pregnant and non-drug using CML patients.

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Side Effects of CML Treatment

Lots of side effects might fade away over time. And some become more tolerable. Most of these side effects don’t require the drug to be ceased. Talking about side effects in the long run with your physician could make you feel more comfortable.

Most frequent side effects of Imatinib.

  • Lumps on body depending on liquid levels.
  • Swelling around the eyes.
  • Nausea.
  • Vomiting.
  • Muscle cramps.
  • Diarrhea.
  • Rash.

Also there is a possibility of mineral loss in bones.

Your physician will assess you for these side effects.

Most frequent side effects of Dasatinib.

  • Decrease in whether red spheres, white spheres or blood scales.
  • Liquid accumulation in the chest area.
  • Diarrhea.
  • Liquid accumulation in other parts of the body (edema).
  • Headaches.
  • Low calcium in blood.
  • Small changes in liver functions.

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Stem Cell Tranfusion

Stem cell transfusion is a crucial treatment for some CML patients. Allogenic stem cell transfusion is the only cure available for CML. The aim of the treatment is replacing the diseased bone marrow with a new one. The stem cell in given to the patient either with blood or bone marrow. These stem cells later on disintegrate to form white spheres, red spheres and blood scales.

Allogenic stem cell transfusion requires a donor. Tissue compatibility tests for the donor and the patient should take place (HLA Tissue analysis). The first people to be considered as donors are the siblings of the patient. In case no compatible tissue is found it is necessary to turn to international centers.

7 out of 10 CML patients achieve full recovery after allogenic stem cell transfusion. Howvever this process sometimes comes with the risk of severe complications. Young people provide more heartening results after this treatment. For patients over 60 it is only considerable if there is no response to oral treatments and the patient has a donor ready.

Transfusion decision is based on

  • Patient's age
  • General condition,
  • Tissue compatibility between donor and the patient
  • Response level to oral treatments 

In case a transfusion decision has been made for you it is important you assess the gain/loss ratio with your physician.

Donor lymphocyte infusion  

Even after allogenic stem cell transfusion it is possdible to see the CML symptoms (relapse). These patients could be treated with Imatinib, Nilotinib and Dasatinib. Another form of treatment is renewing the stem cell transfusion. Lymphocytes taken from the stem cell donor could be transfused (Donor lymphocyte infusion).

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Imatinib

This drug is mainly used against intestine and stomach tumors.

It aims for the tyrosine kinase proteins called such as Bcr-abl and C-Kit. Stops the fission of cells by overwhelming the proteins on the diseased cells.

Always remind your physicians, dentists, pharmacist and nurses that you’re using Imatinib.

Consult your physician before taking Imatinib:

  • If you have any allergies against any drugs, food, dyes or additive.
  • If you have any liver diseases because it is secreted via liver.
  • If you have any coronary diseases or coronary failures.
  • If you have kidney diseases, diabetes, infections or gout.
  • If you’re using any blood diluters (Coumadine).
  • If you’re pregnant or trying to get pregnant.
  • If you’re using birth control pills.
  • If you’re breastfeeding.
  • If you’re using any other drugs (including herbals).

Which drugs should I watch out for?

Rifampin, fenotion, Phenobarbital, St. John’s wort, Carbamazepine, Itroconazol, Ketoconazol, Nefazodone, Erthromycin, Clarithromycin, Ritonavir and other drugs used for HIV treatment interact with Imatinib. These drugs can either decrease or increase the Imatinib level in blood.

Imatinib could also decrease the amount of paracetamol, birth control pills, cyclosporine and calcium channel blockers in blood.

If you’re on Coumadine the drug level could be affected. During this phase you might need to use another blood diluter.

Always remind your physicians, dentists, pharmacist and nurses which vitamins, drugs and herbal supplements you’re using along with your alcohol intake habit.

What Can I Eat?

Grapefruit or grapefruit juice affects the Imatinib level in your blood.

How Should I Use It?

Usually once a day and orally in the morning. Because there is a chance of upsetting your stomach it is recommended to be taken after eating and with a glass of water.

In case it should be taken twice the second one could be taken in the evening.

Should be kept away from heat, humidity and children at all times.

Nausea, vomiting and diarrhea are possible side effects and your physician should recommend other drugs to eliminate those.

Water accumulation in the abdomen or chest and swellings around the eyes could be seen. In case you had swellings on your hands, feet and around your eyes, difficulties while breathing and started to gain weight, let your physician/nurse know immediately. Blood tests related with the the liver should be taken regularly. Have your physician know whether you have a liver disease.

Sometimes after starting to take Imanitib rash on skin could be seen.

White sphere and blood scale count could decrease. This should be monitored with full blood count in regular intervals. While the decrease in blood scales might result in easier bleeding, the decrease in white spheres makes the body more prone to infections.

While using Imanitib, never have a vaccination shot without your physician’s approval. Because your immune system is directly affected, you might become an easier target for infections. Also you should stay away from individuals who recently had live virus vaccinations.

Frequent Side Effects

Nausea, vomiting, diarrhea, swellings around the eyes, weight gain, muscle/joint/abdomen aches, rash, fatigue, headache.

Less Frequent Side Effects

Decrease in blood scales, bleeding, decrease in white spheres, water accumulation in the abdomen/heart/liver cortex, heartburn, itching, difficulty in breathing, constipation, decrease in the potassium level in the blood.

Rare Side Effects

Deterioration in livers tests, severe rash, decrease in red spheres, heart failure.

It is possible for other side effects to occur in which case you should immediately consult your physician.

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Dasatinib

This drug is mainly used for KML and sıme types of ALL. It’s main target is tyrosine kinase proteins such as Bcr-Abl, C-Kit, PDGFRb and Src. Stops the fission of cells by overwhelming the proteins on the diseased cells. You should always tell any physicians, dentists, pharmacists or nurses that you are using Dasatinib.

Consult your physician before taking Dasatinib:

  • If you have any allergies against any drugs, food, dyes or additive.
  • If you have any liver diseases because it is secreted via liver.
  • If you have lactose indigestion
  • If you have any coronary diseases or coronary failures.
  • If you have kidney diseases, diabetes, infections or gout.
  • If you’re using any blood diluters (Coumadine).
  • If you’re pregnant or trying to get pregnant.
  • If you’re using birth control pills.
  • If you’re breastfeeding.
  • If you’re using any other drugs.

Always remind your physicians, dentists, pharmacist and nurses that you’re using Dasatinib.

Which drugs should I watch out for?

Rifampin, fenotion, Phenobarbital, Carbamazepine, Itroconazol, Ketoconazol, Nefazodone, Erthromycin, Telithromycin, Clarithromycin, Ritonavir and other drugs used for HIV treatment interact with Dasatinib. These drugs can either decrease or increase the Dasatinib level in blood.

St. John’s Wort should not be used with Dasatinib because it may alter the blood levels.

Dasatinib could also affect the Cyclosporine, Alfentanil, Fentanil, Pimozide, Sirolimus, Tecrolimus and Ertamine levels. Anti acids causes weaker absorption of Dasatinib. In case you’re using an anti acid be sure to take prior or after two hours of Dasatinib.

Any drugs related to heartburn, acid reflux and ulcer drugs lower the acidity of the stomach. H2 blocker, proton pump inhibitor (Famodin, Omeprol, Pantpas) should be told to your physician.

Dasatinib could cause bleedings because of its anti coagulation structure. Please tell your physician if you’re using Coumadine, Plavix, Ticlid, Aspirin and Vitamin E.

Always remind your physicians, dentists, pharmacist and nurses which vitamins, drugs and herbal supplements you’re using along with your alcohol intake habit.

What Can I Eat?

Grapefruit or grapefruit juice affects the Dasatinib level in your blood.

How Should I Use It?

Usually once a day and orally in the morning. There is no difference whether you take it with or without food. Should be kept away from heat, humidity and children at all times.

Dasatinib could lower the blood scale count. Please tell your physician if you’re using Coumadine, Plavix, Ticlid, Aspirin and Vitamin E. The decrease in blood scales could cause bleedings inside the digestive system, mouth, nose or brain.

Usually a few months into the treatment red spheres level could become lower. Difficulty in breathing and fatigue are common symptoms. In order to counter these affects your physician could recommend another drug or a blood transfusion. White sphere could decrease resulting with a more prone-to-infections system. Coughing, phlegm, painful urinating, fever and tremors should be reported to your physician immediately.

While using Dasanitib, never have a vaccination shot without your physician’s approval. Because your immune system is directly affected, you might become an easier target for infections. Also you should stay away from individuals who recently had live virus vaccinations.

Water accumulation in the abdomen or chest and swellings around the eyes could be seen. In case you had swellings on your hands, feet and around your eyes, difficulties while breathing and started to gain weight, let your physician/nurse know immediately. Blood tests related with the the liver should be taken regularly. Have your physician know whether you have a liver disease. According to your liver test results your physician could make arrangements on the dosage or cut you off completely.

Frequent Side Effects

Nausea, vomiting, diarrhea, swellings around the eyes, weight gain, muscle/joint/abdomen aches, rash, fatigue, headache, difficulty in breathing, decrease in white spheres and blood scales.

Less Frequent Side Effects

Water accumulation in the abdomen/heart/liver cortex, bleeding, coronary arhythmia, infections, coughing, vomiting, abdomen pains, chest pains, appetite loss, weight gain/loss, constipation, joint aches, oral contusions, anemia, decrease in calcium/phosphor levels.

Rare Side Effects

Deterioration in livers tests, coronary failure.

It is possible for other side effects to occur in which case you should immediately consult your physician.

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Nilotinib

This drug is used for CML treatment. It aims for the tyrosine kinase proteins called such as Bcr-abl and C-Kit. Stops the fission of cells by overwhelming the proteins on the diseased cells.

Consult your physician before taking Nilotinib:

  • If you have any allergies against any drugs, food, dyes or additive.
  • If you have any liver diseases because it is secreted via liver.
  • If you any heart diseases or coronary arrhythmia (Long QT Syndrome)
  • If you have coronary failure
  • If you have lactose indigestion
  • If you’ve suffered from pancreatic inflammation
  • If you have any coronary diseases or coronary failures.
  • If you have kidney diseases, diabetes, infections or gout.
  • If you’re using any blood diluters (Coumadine).
  • If you’re pregnant or trying to get pregnant.
  • If you’re using birth control pills.
  • If you’re breastfeeding.
  • If you’re using any other drugs.

Always remind your physicians, dentists, pharmacist and nurses that you’re using Nilotinib.

Which drugs should I watch out for?

Some drugs can increase the level of Nilotinib in the blood. Among these are;

  • Itroconazol, Ketoconazol, Voriconazol
  • Atazanavir, saquinavir, ritonavir, indinavir, nelfinavir,
  • Clarythromycin, Erythromycin, Telithromycin,
  • Nefazodon

Deksametazon, Fenitoin, Karbamazepin, Phenobarbital and Rifampisin decreases the effect of Nilotinib in the blood. St. John’s Wort should not be used with Nilotinib because it may alter the blood levels.

Always remind your physicians, dentists, pharmacist and nurses which vitamins, drugs and herbal supplements you’re using along with your alcohol intake habit.

What Can I Eat?

Grapefruit or grapefruit juice affects the Nilotinib level in your blood.

How Should I Use It?

Usually twice a day in every 12 hours. Should not be taken with food. Should be taken after 2 hours of food. Nothing should be eaten in the first hour after the intake.

Your physician could make adjustments to the dosage in case you have coronary arhythmia, inflammation in the liver/pancreas or any other side effects. Should be kept away from heat, humidity and children at all times.

Nilotinib effects your coronary rhythm. Inform your physician if you have any heart related issues. Before the treatment your physician will ask for an EKG. It is also likely that magnesium and potassium level test would be requested. On the course of the treatment if you suffer from any change in your heart rhythm, tachycardia, chest pains, blackouts or seizures inform your physician immediately. Specifically the latter should require immediate medical attention.

Nilotinib could cause water accumulation in the heart/liver/abdomen cortex and swellings around the eyes, hands and feet. In case you had swellings on your body and started to gain weight, inform your physician/nurse immediately.

After a few weeks into the treatment blood scale levels could decrease. Please inform your physician if you’re using Coumadine, Plavix, Ticlid, Aspirin and Vitamin E. The decrease in blood scales could cause bleedings inside the digestive system, mouth, nose or brain.

Red spheres level could become lower. Difficulty in breathing and fatigue are common symptoms. In order to counter these affects ypur physician could recommend another drug or a blood transfusion.

Usually after a few weeks into treatment white spheres could decrease resulting with a more prone-to-infections system. Coughing, phlegm, painful urinating, fever and tremors should be reported to your physician immediately.

Blood tests related with the the liver should be taken regularly. Have your physician know whether you have a liver disease. According to your liver test results your physician could make arrangements on the dosage or cut you off completely.

While using Nilotinib, never have a vaccination shot without your physician’s approval. Because your immune system is directly affected, you might become an easier target for infections. Also you should stay away from individuals who recently had live virus vaccinations.

Frequent Side Effects

Nausea, vomiting, diarrhea, swellings around the eyes, weight gain, rash, fatigue, headache, constipation, decrease in white spheres or blood scales.

Less Frequent Side Effects

Changes in heart speed, swellings around the eyes/feet/hands, bleeding, coronary arhythmia, infections, coughing, vomiting, abdomen pains, chest pains, appetite loss, weight gain/loss, constipation, joint aches, oral contusions, anemia, decrease in calcium/phosphor levels, difficulty in sleeping, disruption in the pancreatic and liver functions, hypertension, rhinocleisis, dizziness.

Rare Side Effects

Infections, hair loss, weight gain/loss, coronary failure, changes in the sodium, magnesium, phosphorus levels.

It is possible for other side effects to occur in which case you should immediately consult your physician.

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This site is being served by a diagnosed CML patient. KMLTurkiye.com is serving the purpose to share the processes, treatment and side effects between diagnosed CML patients and their relatives. KMLTurkiye.com is not intended for medical advice in any way. Each treatment applied to CML patients are strictly personal and always should be advised to their own doctors by themselves.
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