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Answer 2
  1. Imatinib mesylate. This patient requires treatment for her CML. Transfusions are unlikely to be beneficial because the symptoms she is experiencing are not likely related to her moderate anemia and mild thrombocytopenia. Hydroxyurea, interferon-a, and imatinib can reliably control leukocytosis, thrombocytosis, and splenomegaly caused by CML. Interferon-Α and imatinib can also induce cytogenetic responses, which has been associated with improved survival; however, hydroxyurea therapy almost never induces a cytogenetic response. A large, multicenter, randomized trial comparing imatinib with a combination of interferon and cytarabine demonstrated that patients with chronic phase CML are much more likely to attain a complete cytogenetic response when treated with imatinib (76% versus 14.5%) and with markedly less toxicity.1 Patients with accelerated phase CML can also have major cytogenetic responses when treated with imatinib, although a higher dose than that used for chronic phase CML is necessary,2 underscoring the importance of accurately characterizing this patient’s disease status. AML induction therapy would not be considered here unless the bone marrow biopsy unexpectedly revealed that the patient was in the terminal blast crisis phase of CML.

    1. O’Brien SG, Guilhot F, Larson RA, et al. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med 2003;348:994-1004.
    2. Talpaz M, Silver RT, Druker BJ, et al. Imatinib induces durable hematologic and cytogenic responses in patients with accelerated phase chronic myeloid leukemia: results of a phase 2 study. Blood 2002;99:1928-37.

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