Gleevec

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Gleevec scientifically known as CGP57148 (imatinib) and formerly known as STI571 is the new member of a class of agents that act by binding using a kinase inhibitor to try to control CML. It acts as a specific kinase inhibitor, which induces complete remission in the population of those with chronic-phase CML. As a result of the treatment there are no immature cells seen in the blood, and the spleen returns to its normal size in a complete hematologic response (CHR). Equally patients using Gleevec see a dramatic reduction of their tumor clone cells, and restores normal regulatory behavior in the leukemic clone. As well as, the occurrence of a marked increase in the proportion of blast cells, this in addition leaves cells undamaged. If no cells with the Philadelphia chromosome are found in the blood or bone marrow, then patients obtain a complete cytogenetic response (CCyR).

The process by which Gleevec acts to inhibits bcr-abl in CML patients is by helping to reverse uncontrolled cell growth where Gleevec acts on a molecular target by a method that is more specific to cancer cells. It was shown that there is a substantial in vivo inhibition of the enzymatic activity of BCR-ABL at the 400 mg dose. which decreases phosphorylation of CRKL (a substrate of BCR-ABL). Since Gleevec was designed as an inhibitor of a specific receptor linked with CML, Gleevec also inhibits the Platelet-derived growth factor receptor tyrosine kinase and the c-kit tyrosine kinase.
Furthermore, because BCR-ABL is critical to the development of CML, the mutation must be eradicated from the patient and phosphorylation by bcr-abl may play a role in down-regulation of tyrosine kinase signaling.these on and off switches know to be Kinases and phosphatases are ...

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...se them to become resistant to Gleevec. These mutations change the shape of bcr-abl to some extent that the treatment will not work on them, such that Gleevec can no longer bind to bcr-abl and activate it; which leads to gleevec resistance within patients with CML. Yet, using another Kinase inhibitor as an alternative to Gleevec which would block the mutated version of bcr-abl that causes resistance with Gleevec could be used to treat the new mutated version of bcr-abl. Such as: dasatinib, nilotinib, bosutinib, or ponatinib. Subsequently, even if the bcr-abl gene is not found in the patients blood, that still doesn't guarantee they are cured for now, so they are recommended to stay on the drug indefinitely. If all fails then patients are told to consider stem cell transplant as a last resort, especially for younger people who have a donor with a matching tissue type.

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