[Chronic myeloid leukemia and tyrosine kinase inhibitors]

Quantification of Imatinib in Human Plasma by High-Performance Liquid Chromatography-Tandem Mass Spectrometry

Imatinib, also known as Gleevec or Glivec, is a selective tyrosine kinase inhibitor currently used for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML) and for other malignant pathologies. We have developed a LC-MS-MS [corrected] method that could be used for imatinib therapeutic drug monitoring in plasma. After a liquid-liquid extraction, the imatinib and its deuterated internal standard were eluted on an XTerra RP18 column with a gradient of acetonitrile-ammonium formiate buffer 4 mmol/L, pH 3.2. Imatinib was detected by electrospray ionization mass spectrometry with multiple reaction-monitoring mode. The calibration curves were linear over the range 10-5000 ng/mL. The limit of quantification was set at 10 ng/mL. The bias was lower than 8%. Intra-day and inter-day precisions were lower than 8%. The extraction recovery was higher than 90%. This method is simple, adapted to routine application, and allows accurate therapeutic monitoring of imatinib. It can be used to evaluate patient adherence to daily oral therapy, drug-drug interactions, or pharmacokinetic/pharmacodynamic relationships.

Chronic myelogenous leukemia: elements of conventional chemotherapy and an overview of autografting in the treatment of the chronic phase

Chronic myelogenous leukemia (CML) consists of a clonal malignancy that arises from a pluripotent hematopoietic stem call. In most cases, neoplastic cells are characterized by the formation of a shortened chromosome 22 called the Philadelphia chromosome. It results from a reciprocal translocation between long arms of chromosomes 9 and 22. A rearranged gene (bcr-abl) is the consequence of this translocation, and it may be considered as the first step toward leukemic transformation. Conventional chemotherapy of CML in the chronic phase is unable to suppress the Ph+ leukemic clone. The treatment with the IFNalpha may induce an overall cytogenetic response rate of 40-50% of patients. Autografting for patients with CML in chronic phase may induce a 53% overall cytogenetic response rate with a duration of disease-free time and survival from the autograft ranging, respectively, from 4 to 24 mo and from 8 to 40 mo.