Myelodysplastic Syndrome Guidelines

 What is myelodysplastic syndrome?

A group of disorders that causes abnormal blood cells is called myelodysplastic syndrome. Generally, the myelodysplastic syndrome occurs due to dysfunction of bone marrow that produces blood cells.

Myelodysplastic syndrome symptoms: A myelodysplastic syndrome at an early stage does not cause any sign or symptoms however visible signs appear with the advancement of the disease. These symptoms are:

• Leukopenia 
•         Thrombocytopenia 
• Anemia
• Shortness of breath
• Fatigue
• Petechiae

How serious is myelodysplastic syndrome?

There are some complications in the signs and symptoms of myelodysplastic syndrome. These are:

• Reduction in the number of red blood cells can cause anemia and tiredness.
• Due to only a few white blood cells, the chances of serious infection is very high.
• A small cut or bruises may lead to heavy bleeding.

Some patients already suffering from myelodysplastic plastic syndrome may also develop leukemia (a cancer of blood cells).

What is the prognosis for myelodysplastic syndrome?

When people are detected myelodysplastic syndrome at an early stage, the chances of avoiding complications and symptoms is higher in comparison with patients detected at an advanced stage. 

How long can you live with myelodysplastic syndrome?

A patient suffering from myelodysplastic syndrome has been classified into five different classes based on their risk factor. These classes are:

• Very low 
• Low 
• Intermediate 
• High 
• Very high

The average life expectancy of a patient suffering from myelodysplastic syndrome after the diagnosis is:

• Very low: 8.8 years
• Low: 5.3 years
• Intermediate: 3 years
• High: 1.6 years
• Very high: 0.8 years

Myelodysplastic syndrome diagnosis: Some of the Diagnostic techniques used in the detection of Myelodysplastic syndrome are discussed below:

Physical examination: The doctor will look upon the symptoms and physical changes on the skin of the patient.

Blood tests: Blood tests done to determine the number of white blood cells, red blood cells, and platelets. This test is also performed to check the shape, size, and appearance of different blood cells.

Biopsy: A small portion of bone marrow is removed along with the liquid bone marrow to check the sample in the laboratory for any abnormalities.

Can myelodysplastic syndrome be cured?

Unfortunately, myelodysplastic syndrome can't be cured completely however treatment processes are done to minimize the side effects, symptoms, and avoid any complications.

Myelodysplastic syndrome drug treatment: Some of the major drug used in the treatment of myelodysplastic syndrome which is used for:

Increase the number of blood cells: Drugs that work as the growth factor include darbepoetin alfa (Aranesp), epoetin alfa (Epogen, Procrit). 

Suppresses your immune system: There is some medication that decreases the need for red blood cell transfusion.

Mature blood cells: Some drugs help in increasing the life expectancy and decreasing the risk of acute myelogenous leukemia. These drugs include decitabine (Dacogen) and azacitidine (Vidaza).

What is azacitidine used for?

Azacitidine (Vidaza), is used for the treatment of myelodysplastic syndrome, for which it holds the approval by the U.S. FDA on May 19'th, 2004.

Apart from this, It is also sometimes prescribed for the treatment of acute myeloid leukemia, as a hypomethylating agent, and for the treatment of chronic myelomonocytic leukaemia. 

How do you give Azacitidine?

Azacitidine suspension is recommended to be given subcutaneously. Each injection should be given at least 1 inch from the previous site and tender, bruised, red, or hard site should be avoided. 

How long can you take azacitidine?

You can take azacitidine dose every 28 days for a minimum of 6 cycles.The azacitidine treatment should be continued as long as the patient continues to advantage or until disease progression.

What type of drug is azacitidine?

Azacitidine specifically belongs to the class of medicines named demethylation agents. The azacitidine tablets & injection acts by helping the bone marrow in order to produce normal blood cells and by destroying the abnormal cells in the bone marrow.

What is the azacitidine injection price? 

The azacitidine injection price in india is quite reasonable. A WHO-GDP & ISO certified pharmaceutical wholesaler company can provide you the best azacitidine 100 mg injection price. 

Azacitidine is an effective anticancer drug, which is available in injection form. Azacitidine 100 mg injection is taken for at least 6 treatment cycles.

Is azacitidine a chemotherapy?

Azacitidine injection belongs to an anti-cancer chemotherapy drug. This injection is either used alone or in combination with other medications.

How fast does an azacitidine work?

Basically each day injection in a week followed by 3 weeks off treatment comprises one treatment cycle. Azacitidine injection work after the completion of 6 treatment cycles.

Note: To know about this product, please refer to the full prescribing information. 

Read - Breast Cancer Facts

Multiple Myeloma and Mantle cell lymphoma

Prostate Gland Treatment Guidelines

What is prostate gland cancer?
Uncontrollable growth of cells in the prostate gland that produces semen. Tumor in the prostate can be benign or malignant.

Prostate cancer causes: No real cause of prostate cancer has been detected however it is assumed that prostate cancer is caused due to mutation in DNA of cells that causes its abnormal division. There are some risk factors that enhance the chances of having prostate cancer. These factors are:

• Race: Due to unknown reasons it has been seen that prostate cancer is more advanced and aggressive in Black Men as compared to other races.

• Age: the risk of prostate cancer intensifies with age.

• Family History: chances of cancer are high in person, in which this cancer is running in the family.

• Obesity: men suffering from obesity of high risk of cancer.

What are the first signs of prostate problems?

Pain during urination is supposed to be the first sign of prostate cancer however it is followed by pain in ejaculation, burning sensation, and loss of bladder control.

What are the 5 warning signs of prostate cancer?

 At the initial stage of cancer no such signs and symptoms appear however with the advancement of his stage some common prostate cancer symptoms of Cancer are:

• Bone pain
• Trouble in urination
• Blood in semen
• Erectile dysfunction
• Decreased force in the stream of urine
• Discomfort in the pelvic area

List of prostate cancer treatment drug: Some of the approved drugs used in the treatment of prostate cancer as listed below:

• Docetaxel
• Abiraterone Acetate
• Degarelix
• Apalutamide
• Darolutamide
• Bicalutamide
• Casodex (Bicalutamide)
• Cabazitaxel
• Eligard (Leuprolide Acetate)
• Nilandron (Nilutamide)
• Enzalutamide (xtandi 40mg)
• Lynparza (Olaparib)
• Erleada (Apalutamide)
• Lupron (Leuprolide Acetate)
• Firmagon (Degarelix)
• Leuprolide Acetate
• Flutamide
• Mitoxantrone Hydrochloride
• Goserelin Acetate
• Lupron Depot (Leuprolide Acetate)
• evtana (Cabazitaxel)

Prostate cancer Treatment: Some of the best treatment methods for enlarged prostate and prostate cancer are mentioned below:

• Radiation Therapy: This therapy uses a high energy x-ray or Proton beam to directly destroy the cancerous cells.

• Targeted therapy: This therapy uses the small instruction of cell functioning that if inhibited will block the cell growth.

• Immunotherapy: This therapy in the hands or stand and the body's immune system so that it can fight against the cancerous cell.

• Testosterone suppression therapy and androgen axis inhibitors: Mostly all cancerous cells require male hormone androgen for growth and multiplication if with any method this hormone is inhibited then the growth of cancerous cells will be suppressed.

What is the best treatment for enlarged prostate?

Enzamide is one of the best medications used in the treatment of enlarged prostate. It is a nonsteroidal AR inhibitor class drug used in the treatment of non-metastatic and metastatic castration-resistant prostate cancer. It is available in capsule form of concentration 40 mg. Enzamide uses to block the male sex hormone androgen. The enzamide 40 mg capsule is stored at temperatures ranging from 20°C to 25°C (68°F to 77°F).

What are the side effects of Enzamide (Enzalutamide)?

The most commonly reported side effects of enzamide include:

• back pain
• hot flashes
• constipation
• joint pain
• decreased appetite
• diarrhea
• high blood pressure
• weakness or feeling more tired than usual

The enzalutamide dose may be responsible for causing fertility problems in males, which may affect the ability to father children. Discuss with your healthcare professional if you have concerns about fertility.

How does Enzalutamide work? 

It is believed that this medicine works by blocking hormone testosterone's effect on the prostate cancer cells. In absence of testosterone, the prostate cancer cells can’t grow, even if they have reached other organs of the body.

Does xtandi lower your immune system?

It is believed that the xtandi 40 mg doesn't affect your immune system as much as the chemotherapy. The drug is safer for you than the chemotherapy. You will be recommended for blood tests prior to starting treatment and during the treatment. Your doctor will check your general health and might check your levels of blood cells and other existing substances in your blood.

Does enzalutamide kill cancer cells?

As a hormone therapy xtandi used for the treatment of advanced prostate cancer. It is given following surgery and chemotherapy in order to help the body kill the cancer cells.

What type of drug is enzalutamide?

Enzalutamide belongs to the class of drugs called androgen receptor inhibitors. It acts by blocking the androgen effect (a male reproductive hormone) to block the growth as well as spread of cancer cells.

Is enzalutamide a chemotherapy?

The enzalutamide prostate cancer medicine specifically is a hormone therapy that blocks the testosterone from reaching prostate cancer cells. This helps in order to slow the growth of the cancer and can shrink it. 

Who should not take XTANDI? 

This medicine should be avoided for use in women. Do not consume enzalutamide capsules if you are pregnant or may become pregnant. The drug may harm your unborn baby.

In what doses form Enzalutamide comes? 

Enzalutamide mainly comes in the form of 40 mg Capsule. It is consumed orally at a dosage of 160 mg once per day (4 capsules).

What is enzalutamide cost? 

The enzalutamide price in india is reasonable. 

Any WHO-GDP & ISO certified pharmaceutical wholesaler company can provide you enzalutamide fda label drug at best price. 

The xtandi cost may vary from branded to non-branded (generic) drugs. 

Note: Prior to initiating any treatment, consult a physician. And, to know more about xtandi please see full prescribing information. 

ovarian cancer stages

A type of cancer that occurs in the female reproductive part focusing on an ovary and its nearby parts is known as ovarian cancer. There are mainly three types of  ovarian cancer  namely: epithelial tumor, stromal tumor, and germ cell tumor.

This cancer is hard to detect at early stage girls no initial symptoms occur but there are several techniques such as biopsy, transvaginal ultrasound pelvic and abdominal CT scan and blood test that help for the diagnosis of ovarian cancer. Some treatment techniques include chemotherapy Radiation therapy and surgery that works by eliminating the tumor by killing the cancerous cells. treatment - Carboplatin 450 mg is the most promising medication which is quite popular amongst the doctors.

Cancer in any part of the ovary that can cause fatalities is known as ovarian cancer. The ovary is the female reproductive part that produces eggs ovarian cancer is a common type of cancer among females in the United States.

There are basically 30 different types of ovarian cancer based on the name of cells from where cancer originated. Ovarian cancer that occurs in the majority of women are:

• Ovarian epithelial cancer: This causes 85 to 90 percent of total ovarian cancer. They are commonly found in the lining of the pelvis and abdomen. They are subdivided into a mucinous, clear cell, endometrioid and undifferentiated cancer.

• Germ cell cancer: Tumor in an egg-producing cell or germ cell of ovaries. This germ cell occurs in less than 2% of total ovarian cancer.

• Sex cord-stromal tumors: This makeup about 1% of total ovarian cancer they've developed from stromal tissue cell that primarily produces female hormones progesterone and estrogen.

There are primary 4 stages of Ovarian Cancer. These stages as mentioned below:

• Stage 1 ovarian cancer: The cancer is confined to the ovaries.
• Stage 2 ovarian cancer: Cancer from ovaries has now spread to pelvic reasons such as the uterus or fallopian tubes.
• Stage 3 ovarian cancer: Cancer from the ovaries has either spread to the lining of the abdomen or to the lymph nodes.
• Stage 4 ovarian cancer: It is the most advanced stage of cancer in which the tumor is metastasized to distant sites such as lung, liver, and spleen.

The most common query that arises in the mind of the patient is can you beat stage 4 ovarian cancer. Stage 4 cancer is hard to cure with current treatment but the goal of treatment is that the patient feels better and to increase its survival rate.

Some common symptoms of ovarian cancer include:

• Pain in body
• Swelling in the pelvic region
• Headache
• Nausea
• Fatigue
• Weight loss

Abdominal bloating; ovarian cancer bloating is swelling in the abdomen by which a belly feels Puffy, full, and hard.

Is ovarian cancer curable?
Ovarian cancer can be cured if diagnosed at an early stage, patients with an advanced stage of cancer can not be cured the treatment can only relieve the symptoms and increase life expectancy.


Carboplatin:  Carboplatin 450 mg injection is used in the treatment of advanced ovarian carcinoma when combined with other chemotherapeutic agents. The most recommended combination of chemotherapy is carboplatin injection and cyclophosphamide. This injection is also applicable to a patient who has previously received any treatment with cisplatin. However, a patient who received prior therapy of cisplatin may have a decreased response rate.

What are the common side effects of carboplatin?

Along with its required effects, the Carboplatin Injection may be responsible for causing some unwanted effects.

More common: Most commonly reported side effects are:

• Pain at place of injection

Less common: Less common are listed as follows:

• Black, tarry stools
• blood in urine or stools
• cough or hoarseness
• fever or chills
• lower back or side pain
• numbness
• tingling in fingers or toes
• painful or difficult urination
• pinpoint red spots on skin
• skin rash or itching
• bleeding or bruising
• tiredness or weakness

Rare: The rare side effects of carboplatin 450 mg include:

• Blurred vision
• ringing in ears
• sores in mouth and on lips
• wheezing

Check with your healthcare professional as soon as possible if any of the above listed side effects occur. 

How is this medicine (Carboplatin) given?

The carboplatin 150mg injection is given by an intravenous (IV) infusion (a slow drip through a needle into your port or through a vein in your arm or hand). 

How does carboplatin work? 

Carboplatin specifically is an anticancer medicine that works by preventing the synthesis of the DNA that is required for the cancer cells in order to divide.

How does carboplatin work in the body?

This drug mainly binds to the patient body’s DNA (the machinery or brain that runs each cell) causing damage that helps prevent the DNA from replicating, which prevents the cell itself from reproducing.

What type of Chemo is Carboplatin?

Carboplatin 450 mg injection is an anticancer (antineoplastic or cytotoxic) chemotherapy medication. It belongs to an alkylating group of medication. 

Do you lose your Hair with Carboplatin?

Treatment with carboplatin is responsible for hair loss, but some patients do have more hair loss than others. Hair growth usually returns upon completion of the treatment.

How long does Treatment take?

Each carboplatin dosage, or cycle, takes 15 to 60 minutes. It may take a bit longer if you are having carboplatin together with other drugs. 

You’ll usually have 1 cycle of carboplatin injection every 21 to 28 days. The total number of cycles will depend on your disease condition. Your healthcare provider will interact about this with you.

What is the price of carboplatin injection? 

The carboplatin 150 mg price in India is quite reasonable. The cost for a vial of 15ml injection of carboplatin 150mg injection is around INR 799. The carboplatin price may vary depending upon the branded to non branded medicines. 

In order to buy carboplatin online, you must choose WHO-GDP & ISO certified pharmaceutical wholesaler company. 

Note: Before initiating any treatment/drug, consult a physician. Do not interrupt, start, or stop taking carboplatin without discussing your healthcare provider. And to know more about carboplatin, please read full prescribing information (PI). 

Chronic Myelogenous Leukemia Treatment

Veenat capsules are anti-cancer drug which is given to the patients to treat the gastrointestinal tumors and leukaemia.

Brand Name: Veenat

Active Ingredients: Imatinib Mesylate

Strength: 100mg / 400mg.

Dosage Form: Capsules / Tablets.

Retail Pack: 30’s Bottle, 120's Bottle, 10's Blister Strip.

Manufactured By: NATCO PHARMA LTD.

Veenat is a generic formulation of imatinib 400 mg Mesylate. This is one of the 1st generic form of Imatinib Mesylate which was introduced in the world. Veenat is manufactured by Natco Pharma. Imatinib is used in treating CML (Leukemia) and gastrointestinal stromal tumors (GIST). Imatinib (Veenat) is also considered as targeted therapy.

There are many countries where Imatinib is not available or approved. Patients from those countries can import medicine on named patient bases. They have to take import permission from their Government before importing the product. They have to provide their prescription and id proof before importing the product. It is always better to check the credential of the exporter before importing the product.

There is another way for the patient to get access to generic medicines from India. Patients can travel to India for consultation with a qualified Doctor and based on the prescription, they can buy 3-6 months of therapy. Patients need to know the legal requirement of their domicile countries before taking medicine along with them. It is advisable not to buy and medicine which contains narcotic substance.

A generic medicine is a broad term. There might be many generic products available for one molecule. The patient/buyer should check the Credibility of the manufacturer before buying the product.

Where can I Buy Veenat 400 mg in India?

Patients from all over the world can buy generic imatinib mesylate 400 mg (Veenat) from Pharmacy shops in India. Patients need to consult Hematologist / Oncologists before starting treatment.   

Can we buy Veenat 400 mg online?

Veenat 400 mg (Imatinib mesylate 400mg Tablet ) is a prescription medicine. The patent should start treatment with Imatinib Mesylate after consultation with treating Physician

Chronic Myeloid Leukaemia (CML)  is a cancer that develops when the blood forming cells of the bone marrow (the soft, spongy tissue in the center of bones) starts producing too many WBC (white blood cells), including immature ones. Managing patients with the CML in chronic phase has changed dramatically with the advent of the imatinib. The use of the Abl tyrosine kinase (TK) inhibitor, imatinib mesylate 400 mg (IM), for the treatment of patients with the chronic myeloid leukaemia (CML) in chronic phase appears to be well tolerated and effective

FAQ

How long can you live with chronic myeloid leukemia?

Is CML leukemia is fatal?

Is chronic myeloid leukemia curable?

Is CML considered cancer?

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T-Cell Acute Lymphoblastic Leukemia Guidelines

Leukemia is generally known as a group of cancers that develop in the bone marrow. Under normal circumstances, the bone marrow contains a small number of immature blood cells, sometimes called blast cells. These immature blood cells mature and turn into red cells, white cells, and platelets, which are eventually released into the bloodstream. Leukemia originates in developing blood cells, which have undergone a malignant change. Rather than maturing precisely these cells grow and start to multiply in an uncontrolled way and interfere with the production of normal blood cells in the bone marrow. The maximum cases of leukemia originate in the developing white cells. In a few cases, leukemia develops in other blood-forming cells, for instance in developing platelets or red cells.

Types of leukemia:  There are basically four types of leukemia:
• Acute myeloid leukemia (AML)
• Acute lymphoblastic leukemia (ALL)
• Chronic myeloid leukemia (CML)
• Chronic lymphocytic leukemia (CLL)

Both adults and children can develop leukemia but certain types are more common in different age groups.

What is T-Cell Acute Lymphoblastic Leukemia?

 T-cell lymphoblastic leukemia, also known as precursor T-lymphoblastic leukemia, basically is a form of lymphoid leukemia and lymphoma in which too many T-cell lymphoblasts (immature WBC) are detected in the bone marrow, tissues and blood, particularly mediastinal lymph nodes.

It is generally uncommon in adults, but it represents approx 15% of childhood acute lymphoblastic leukemia and about 90% of lymphoblastic lymphoma.

T-Cell Acute Lymphoblastic Leukemia Symptoms: A diagnosis of ALL is usually made through blood and bone marrow tests, based on information on blood cell counts blood chemistry studies and bone marrow sampling.

Patients with ALL often have several non-specific symptoms, including weight loss, fever, night sweats, fatigue, and loss of appetite.

T-Cell Acute Lymphoblastic Leukemia Causes: Acute lymphocytic leukemia mainly occurs when a bone marrow cell develops errors in its DNA. The errors indicate the cell in order to continue growing as well as dividing when the healthy cells will normally not divide and eventually die. When this takes place, the production of blood cells becomes abnormal.

T-Cell Acute Lymphoblastic Leukemia Diagnosis: Your doctor will ask about your symptoms and medical history. They’ll do a physical exam to look for swollen lymph nodes, bleeding and bruising, or symptoms of infection.

If your healthcare provider suspects leukemia, they may do tests, including:

• Blood tests: A complete blood count (CBC) shows how many of each type of blood cell you have. A peripheral blood smear checks for changes in how your blood cells look.

• Bone marrow test:. Your doctor will put a needle into a bone in your chest or hip and take out a sample of bone marrow. A specialist will observe it under the microscope for the signs of leukemia.

• Imaging test:. X-rays, CT scans, or ultrasounds can tell your doctor whether cancer has spread.

• Spinal tap: This is also known as a lumbar puncture. Your doctor will use a needle to take a sample of fluid from around your spinal cord. A specialist can look at it to see if cancer has reached your brain or spinal cord.

What is the fastest way to cure T-Cell Acute Lymphoblastic Leukemia?

T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive cancer that is curable with proper treatment.

In today's era, the way T-cell acute lymphoblastic is treated is with the prolonged schedule that includes several various kinds of chemotherapy drugs given over several months. In addition, the phase of intensive chemotherapy (which mainly lasts for 4 to 8 months) is followed by the oral chemotherapy for a long period of time, typically from 1.5 to 2 years or even longer.

T-Cell Acute Lymphoblastic Leukemia Treatment: The aim of treatment is to induce a lasting remission, defined as the absence of detectable cancer cells in the body (usually less than 5% blast cells in the bone marrow).

Over the past several decades, there have been strides to increase the efficacy of treatment regimens, resulting in increased survival rates. Possible treatments for acute leukemia include chemotherapy, radiation therapy, intensive combined treatments (including stem cell or bone marrow transplants), and/or growth factors.

New chemo medications are also being developed anelarabine side effectss well as tested. For instance, clofarabine (Clolar) is approved to treat childhood ALL and shows promise in early studies of adults with this disease. Atriance (nelarabine injection is a newer drug that can be used to treat T-cell ALL.

Side Effects: The most commonly reported nelarabine side effects may include:

• fever
• nausea
• vomiting
• diarrhea
• constipation 
• headache 
• sleepiness 
• blurry eyesight
• trouble breathing
• unusual bleeding
• decreased blood counts 

These are not entire adverse reactions associated with atriance injection. Discuss with your healthcare provider in order to get more information.

What are the risks associated with taking the medication nelarabine?

The drug nelarabine may be responsible for causing serious system problems including: extreme sleepiness, numbness and tingling in the hands, fingers, feet or toes.

Also some rarely reported complications may include; weakness, seizures, coma, and paralysis. The tumor lysis syndrome can also be appeared as an outcome of the treatment of leukemia..

Can you take the drug Atriance during pregnancy?

The atriance 250 mg should be avoided by pregnant women. It may be responsible for causing harm to a baby if conceived prior to, during or soon following treatment.

How does Nelarabine work? 

Nelarabine is a group of medications named antimetabolites. It is believed to work in order to destroy the quickly dividing cells (cancer cells).

Atriance:  Atrience 250 mg is mainly used for the treatment of patients with T-cell acute lymphoblastic 15 leukemia and T-cell lymphoblastic lymphoma whose disease has not responded to or has 16 relapsed following treatment with at least two chemotherapy regimens.

Atrience 250 mg is an intravenous medicine. This means it is given through a tube in your vein.  

Chronic Myeloid Leukemia Guidelines

Leukemia is basically a cancer of the blood. Different forms of leukemia exist, which depends on what sort of blood cell is affected. The term Chronic basically describes the slow progression or a gradual, and the term myeloid represents the origin from myeloid cells, which are more likely immature cells that generally become mature RBC, WBC, or Platelets. In the phase of chronic myeloid leukemia (CML), the bone marrow produces excess myeloid blood cells which are at various maturation stages including cells known as immature granulocytes, myeloblasts, and metamyelocyte. Basophils and platelets are more often overproduced at the time of diagnosis. Excess production of myeloid blood cells in the bone marrow ultimately prevents the normal production of red blood cells, which are important in delivering oxygen to all the cells in the body, and may also decrease the production of thrombocytopenia or platelets. Platelets play a crucial role in order to stop the bleeding.

Chronic Myeloid Leukemia Symptoms: Patients with chronic myeloid leukemia (CML) may be diagnosed at a routine checkup, or after seeking medical care due to lack of energy and fatigue from the anemia, or abdominal pain or discomfort, or bleeding, and rarely bruising from the insufficient platelets. Enlargement of the spleen, called splenomegaly, leads to the left chest and abdominal discomfort, early satiety, or Changement in the bowel patterns. Other possible signs and symptoms include shortness of breath, bone pain, and fever. At diagnosis, most of the patients have a white blood count (the number of white blood cells circulating in the blood) increased above normal.

What are the stages of CML: CML is often divided into three phases. In the case of absence of the intervention, CML typically starts in the chronic phase, and over the course of the progression of several years, it appears in an accelerated phase and ultimately to a blast crisis. Blast crisis phase is the terminal phase of CML and clinically behaves like Acute Leukemia. Early initiation of drug treatment usually stops the progression.
• Chronic Phase
• Accelerated Phase
• Blast Crisis

Chronic Myeloid Leukemia Diagnosis: Diagnosis CML typically presents with leukocytosis, a profound left-shift in WBCs, thrombocytosis, and splenomegaly, although more commonly today is diagnosed on a routine blood test. The differential diagnosis includes other myeloproliferative disorders, chronic myelomonocytic leukemia, and chronic neutrophilic leukemia. The diagnosis of CML is confirmed by demonstration of the Philadelphia chromosome, on bone marrow or peripheral blood samples. This may be achieved by conventional cytogenetics, fluorescence in-situ hybridization (FISH), or polymerase chain reaction (PCR) in either marrow or blood.

What is the best treatment for Chronic Myeloid Leukemia: The treatment should take place only in centers used to treat CML and offering an adequate multidisciplinary infrastructure. Whenever possible, the treatment must be offered in the form of clinical trials. Treatment of CML is tailored to the individuals based on the phase of disease at the time of diagnosis. Unlike rigid tumors, surgical resection and radiation therapy do not serve a role in order to the management of the CML.

• Targeted drug therapy (kinase inhibitors, imatinib mesylate 400 mg)
• Allogeneic stem cell transplant (SCT)
• Chemotherapy (hydroxyurea)
• Clinical trials with new agents

Imatinib (Gleevce): imatinib mesylate 400 mg is the only BCR-ABL tyrosine kinase inhibitor indicated for first-line treatment of CML. It is considered as the standard treatment since FDA approval in 2001. The goal of treatment is to reduce the number of cells containing the Ph chromosome.

The first of this new class of drugs was approved by the US FDA in 2001. gleevec 400 mg has the potential in order to inhibit the progression of Chronic Myeloid Leukemia in the majority of patients sufficiently in order to achieve the regrowth of their normal bone marrow stem cell population (a cytogenetic response) with stable proportions of maturing WBC. Because several leukemic cells persist in about all the patients, so the treatment must be continued indefinitely. Since the advent of imatinib (Veenat 100 mg), CML has become first cancer in which a standard medical treatment may give to the patient a normal life expectancy.

Adverse effects: The most common non-hematologic side effects with Veenat 100 mg (imatinib) are fluid retention and edema, nausea, diarrhea, skin rash, and muscle cramps. Most are grades 1-2. Congestive heart failure/LV dysfunction and pleural effusions have been observed, but their association with imatinib is uncertain. Other side effects may include hepatotoxicity, fatigue. Serious adverse effects are very rare. Low dose diuretics can be very useful for edema. For skin rash antihistamines and topical corticosteroids are helpful, and anti-nauseants for nausea.

What are the differences between CLL (Chronic Lymphocytic Leukemia) and CML (Chronic Myelogenous Leukemia)?

Difference between CML and CLL

• CML stands for chronic myeloid leukemia also known as chronic myelogenous leukemia which is a type of cancer in the bone marrow.
CLL stands for chronic lymphocytic leukemia is a type of cancer of white blood cells in the bone marrow.
• In the case of CML, myeloid stem cells are involved while in CLL lymphoid B or T cells are affected.
• CML generally occurs to middle age people however CLL affects old age people.
• About 20% of the patients suffering from CML do not show any symptoms while in the case of CLL patients range from 50% who are asymptomatic.
• CML is caused by tyrosine kinase pathway chromosomal translocation however CLL is represented by chromosomal abnormalities by chromosome deletion and possible somatic hypermutation.
• Common symptom of CML is splenomegaly whereas in CLL is lymphadenopathy and hepatosplenomegaly

Other Common Drugs to treat Chronic Myeloid Leukemia: The following list of medications are in some way related to, or used in the treatment of Chronic Myeloid Leukemia.

Hydroxyurea: The hydroxyurea medication is used in chronic myelogenous leukemia. It is recommended to be consumed orally (by mouth). 

This antineoplastic family of drug may cause some common side effects include: 

• bone marrow suppression
• fevers
• loss of appetite
• psychiatric problems
• shortness of breath
• headaches

This drug comes in the capsule form as the strength of 500 mg. The hydroxyurea 500 mg is believed to act by blocking the making of DNA. 

Cytarabine: Cytarabine is a chemotherapy medication used in order to treat chronic myelogenous leukemia (CML). It is recommended to be given by injection into a vein, under the skin, or into the cerebrospinal fluid. 

This antimetabolite and nucleoside analog families of drug may cause some common side effects include: 

• rash
• bleeding
• vomiting
• diarrhea
• liver problems
• bone marrow suppression
• ulcer formation in the mouth 

This drug comes in the form of injection, which is believed to act by blocking the function of the DNA polymerase. 

What kind of drug is cytarabine?

The cytarabine 100 mg belongs to the group of medicines named antimetabolites. It works by resisting or blocking the growth of cancer cells. 

Note: Before starting any treatment, please consult a physician. In order to know more about any medication, read full prescription information. 

Metastatic Colorectal Cancer Treatment Guidelines

Metastatic Colorectal Cancer: A cancerous cell is a group of abnormal cells that grow and spread continuously when a cell becomes cancerous in colon or rectum then it is known as colorectal cancer.
The tumor has a property of breaking down. The tumor breaks and spreads to other parts of the body by the bloodstream or using the lymphatic system. Thus this can cause malignancy and the process of spreading and breaking down of tumors is known as metastatic. The cancer is always named by the part where it started originally so when colorectal cancer is spread by the process of metastatic this is known as metastatic colorectal cancer.

The colorectal cancer metastasis and deposits to its most common site which is the liver. Colorectal cancer can also spread through the bloodstream to the brain, bones, lungs, and spinal cord.

Metastatic Colorectal Cancer Symptoms: There are few symptoms of metastatic colorectal cancer which are mentioned below:

• Constipation
• Diarrhea
• Rectal bleeding
• Abdominal cramping
• Anemia
• Fatigue
• Blood in stool
• Stool color becomes black or Maroon
• Unexplained weight loss
• Shortness of breath
• Jaundice
• Abdominal swelling
• Tiredness
• Headache
• Bone pain
• Seizure

A metastatic colorectal cancer diagnosis: Few patients can see the symptoms at the initial stage while in a few cases the symptoms appear at the final stages. The main test of diagnosing metastatic colorectal Cancer is Colonoscopy which is carried by biopsy.

Colonoscopy is used to see the cancerous cell and its activity. A biopsy is done to check whether the tumor is metastatic or not. 

The Colonoscopy or imaging test of metastatic colorectal cancer includes:

• CT scan: CT scan is used to check the spreading of colorectal Cancer to lymph nodes or other parts of the body. CT scan is also very helpful in the case of biopsy as it is used to determine the metastases in organs.

• Ultrasound: Basically ultrasound is done to check whether colorectal cancer has spread to the liver or not.

• MRI: MRI scan is done in the region of pelvic as well as abdominal areas to check the spreading of cancer.

• X-ray: A chest x-ray is done to check the metastases of colorectal cancer to the chest. X-ray is also used in testing the bone metastases.

Metastatic colorectal cancer treatment: The treatment of colorectal cancer depends upon the size of the tumor, location of the tumor, and spreading of tumors. There are several factors that affect the cancer treatment of patients such as overall health, age, and potential.

However, this is a fact that metastatic colorectal cancer is barely curable. The main objective of the treatment of metastatic colorectal cancer is to prevent symptoms and increase the life expectancy of the patient.

Below are mentioned a few treatment methods of metastatic colorectal cancer:

• Surgery: surgery of a tumor is done after a trusted pre-clinical trial which determines whether the tumor is metastasis or not. Surgery is done to avoid blockage of the colon as well as to prevent complications.

• Radiation therapy: High energy X-rays are used to destroy the cancer cell in Radiation therapy. Radiation therapy is generally used in the treatment of rectal cancer as a tumor stay in a nearby location.

• Meditation: Medication used in the treatment of metastatic colorectal cancer is given through the bloodstream which reaches cancerous cells throughout the body. The most common way to give medication is either in the form of pills or inject intravenously. There are few therapies help in the  treatment of metastatic colorectal cancer:

• Chemotherapy 

• Immunotherapy 

• Targeted therapy

Chemotherapy: chemotherapy is the combination of a drug that is used in the treatment of cancer cells. Chemotherapy is used before the surgery to shrink the cancer cell and after the surgery to wipe out all the remaining cancerous cells.

Immunotherapy: The natural immune system of the human body is boosted with the help of different medications to fight against cancerous cells.

Targeted therapy: In targeted therapy the protein formation activity or genetic changes of cancerous cells is detected and its normal functioning is inhibited with the help of drugs. The best drug used in the treatment of metastatic colorectal cancer is regorafenib who has already received chemotherapy and other targeted therapy. The most effective dosage is as regorafenib 40mg.

What is regorafenib used for?

As an oral multi-kinase inhibitor, the drug regorafenib 40 mg is used for the treatment of metastatic colorectal cancer, advanced gastrointestinal stromal tumours and advanced hepatocellular carcinoma. 

Side Effects of regorafenib: The commonly reported regorafenib side effects may include:

• Fatigue
• Diarrhea
• Stomach pain
• Weight loss
• Infection
• Weakness
• Tiredness
• Hoarseness
• Voice changes
• Loss of appetite
• High blood pressure
• Decreased food intake
• Hand-foot skin reaction (HFSR)

Apart from these events, this drug may be responsible for causing liver problems, which may be serious and fatal.

Is regorafenib a chemotherapy?

This medication specifically is a type of targeted cancer medication named a cancer growth blocker. Regorafenib tablets need to be taken once daily. The regorafenib dose should be taken at the same time, every day. Tablets should be swallowed whole with a drink of water and following a low fat food/meal. 

How does regorafenib work? 

Regorafenib is a group of medicines named antineoplastics, or anti-cancer drugs. This medication is believed to prevent the growth as well as spread of cancer cells by interfering with the development of the blood vessel system that basically supplies the tumour.

How much does regorafenib cost? 

The cost of Regorafenib (nublexa 40 mg) 40 mg for pack 28 tablets is about Rs 59,000. This drug should always be purchased from a WHO-GDP and ISO certified pharmaceutical wholesaler company.

Cost of Nublexa: nublexa 40 mg is available at a very decent and affordable price. A pack contains regorafenib 28 tablets. A respective patient can purchase this drug through any authorized pharmaceutical firm. 

 

Note: Before starting treatment with Regorafenib, consult a healthcare professional. In order to know more about this medication, read full prescription information.