"chronic myeloid leukaemia (CML), a cancer of the white blood cells in which granulocytes (a type of white blood cell) start growing out of control. Glivec is used when the patients are ‘Philadelphia chromosome positive’ (Ph+). This means that some of their genes have re-arranged themselves to form a special chromosome called the Philadelphia chromosome. Glivec is used in adults and children who have been newly diagnosed with Ph+ CML and who are not eligible for a bone marrow transplant. It is also used in adults and children in the ‘chronic phase’ of the disease if it is not responding to interferon alpha (another anticancer medicine), and in more advanced phases of the disease (‘accelerated phase’ and ‘blast crisis’)"...

Gleevec is a kinase inhibitor indicated for the treatment of:...Newly diagnosed adult and pediatric patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in chronic phase...Patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in blast crisis (BC), accelerated phase (AP), or in chronic phase (CP) after failure of interferon-alpha therapy

...If BCR-ABL1 fusion gene (Philadelphia chromosome) is...

We conducted a retrospective study including patients treated for CML between 2003 and 2021….BCR-ABL1 transcript was detected at diagnosis by Reverse Transcriptase-Polymerase Chain Reaction with the b3a2 subtype being the most common (56% of cases)....Imatinib was prescribed for 97% of patients as first line therapy. Complete hematological response was achieved in 100 % of cases....Deep molecular response (DMR) was achieved in 59% of cases with 4% of patients achieving DMR after 6 months, 51% after one year, 34% after 18 months and 11% after 2 years. Event-Free Survival (EFS), Progression-Free Survival (PFS) and Overall Survival (OS) at five years were 63.8%, 100% and 91.4%, respectively.

CONTRADICTING EVIDENCE: CML patients with p190 had a median age of 72.5 years at the diagnosis (range: 50-80) and all received imatinib as a frontline treatment. Only one patient achieved a fluctuating major molecular response (MMR) by 12 months while the rest of the patients showed primary resistance to treatment...By exome sequencing we identified 26 variants in p190-CML samples (median per patient=7, range: 2-10), including variants in ASXL1, DNMT3A and KDM4D genes.

An elderly male Libyan patient was suspected to have chronic myeloid leukemia….Clinical assessment confirmed the first chronic phase of a chronic myeloid leukemia. Chromosomal formula showed an homogeneous structural translocation: t(1;9;12;22)(p35-36;q34;p13;q11) involving four chromosomal regions, 1p35-36, 9q34, 12p13 and 22q11.2. Molecular investigation confirmed the Ph nature of the chromosomal abnormality by showing the BCR-ABL1 transcript. The patient was treated by using Imatinib molecule with a favorable therapeutic response.

CONTRADICTING EVIDENCE: We present a case of a 46-year-old man diagnosed with CML who responded well to imatinib as evidenced by a downtrend in quantitative BCR-ABL mutation to less than 1. He quickly transformed into a blast crisis phase after five months of therapy with imatinib regardless of achieving an excellent initial optimal response. In conclusion, it is possible to transform into a blast phase despite achieving an initial optimal response.

CONTRADICTED EVIDENCE: A 60-year-old woman...She was diagnosed as CML in the chronic phase with positive BCR-ABL1 transcripts. Due to the failure to obtain an optimal response with imatinib treatment, it was switched to nilotinib.