Chief Complaint:

Patient 1 (Jack): Routine monitoring of CML treatment at 12 months 

Patient 2 (Sarah): The patient primarily complains of generalized fatigue

History of Present Illness:

Jack is a 60-year-old Caucasian male who presented to his physician 13 months ago reporting generalized fatigue and early satiety. On physical examination, he was found to have an enlarged spleen (6 finger breadths below the left costal margin). Laboratory studies showed an increased leukocyte count at 112,000 cells/μL. Peripheral blood smear and bone marrow biopsy confirmed the diagnosis of Philadelphia chromosome– (Ph[+])/BCR-ABL positive (bcr-abl[+]) CML. The patient was treated with imatinib, 400 mg/d, and achieved a hematologic response. He now presents to your office for the 12-month routine monitoring of his disease. 

Sarah is a 69-year-old African American female who was given a diagnosis of CML 18 months prior. She was treated with imatinib, 400 mg/d, and hydroxyurea and achieved a hematologic remission at 3 months. At her 6-month follow-up, she had a complete cytogenetic response (CCyR) and was continued on treatment with imatinib, 400 mg/d. She felt well, but was lost to follow-up until recently, when symptoms of generalized fatigue and intermittent low-grade fevers became apparent. She now returns to your office for an 18-month follow-up visit with these symptoms.

Accreditation Statement:

MedCases, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. 

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education.

Disclosure Statement:

As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is MedCases policy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a provider has with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The following was reported: 

Method of Participation:

This Internet-based activity takes approximately 1 hours to complete. You should review the important information on this page, check the box below and click the button to proceed to the case. First-time visitors will be asked to complete their profile. After completing the activity you will answer a multiple-choice post-test and complete an evaluation form online. Once completed, you will be able to save your certificate to your own computer and print it on your own printer.

Statement of Responsibility:

MedCases takes responsibility for the content, quality, and scientific integrity of this CME activity.

Course Director and Principal Faculty:

Moshe Talpaz, MD
Professor of Medicine
University of Michigan
Associate Director for Translational Research
University of Michigan Comprehensive Cancer Center
Associate Chief/Director of Hematologic Malignancies
Division of Hematology/Oncology
Ann Arbor, Michigan

Independent Reviewer:

Jorge Cortes, MD
Proferssor of Medicine 
Deputy Chair, Department of Leukemia 
University of Texas 
MD Anderson Cancer Center 
Houston, Texas

Target Audience:

This activity is intended for medical oncologists, hematologists, hematologist-oncologists, pathologists, and allied healthcare professionals.

Prerequisites:

There are no prerequisites

Statement of Need:

The treatment of CML continues to challenge healthcare providers and patients. Integration of recent therapeutic advances in CML management strategies requires careful consideration of patient-specific characteristics, physician expertise, clinician comfort with the newer therapies, and availability of health system resources. Potential barriers to optimizing CML therapy include rapid advancement in development of novel therapeutic agents, lack of physician awareness of the most recent clinical trial data, swiftly evolving treatment guidelines, reduced awareness of pharmacogenetics and the impact of new assays to monitor patients with CML and concerns about management of potentially significant toxicities from the newer therapeutic agents. If optimal treatment of patients with CML is to be realized, these barriers must be overcome.

Objectives:

After completing this activity, you should be able to: 

• Differentiate between the various therapeutic options in the treatment and management of CML
• Describe newer agents for the treatment of CML
• Implement accepted treatments for CML based on current standards of care
• Describe rationale for the use of newer agents in the accelerated (AP) and last phase of refractory CML                                         

Off-Label Statement/Unapproved Uses:

In accordance with US Food and Drug Administration (FDA) requirements regarding the disclosure of off-label, investigational, or unapproved recommendations for the use of drugs or devices, you are advised that content in this activity contains reference(s) to uses of drugs or devices that are off-label, investigational, or unapproved in the United States. The following information is provided for educational purposes and not to endorse off-label use. 

Non-FDA approved use of imatinib 600 mg is discussed as a treatment option.

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