Interferon a

There are no prospective data on the efficacy of interferon a (IFN-a) in treating aCML. IFN-a has been used, however, in Ph-negative CML, and a retrospective analysis of some of these patients revealed the absence of the BCR-ABL abnormality, rendering the diagnosis similar to aCML. In one report, two of six patients with BCR-ABL-negative CML achieved a CR, while four patients failed to respond.63 In another study involving Ph-negative CML, 21 patients were treated with a daily subcutaneous dose of up to 5 million units/m2of IFN-a.61 Seven of seven (100%) patients with BCR/ABL-positive disease responded, while five of six (83%) patients with BCR/ABL-negative CML and six of eight (75%) patients with CMML failed to respond. The outcome of the two latter groups was worse as well.61 This experience suggests a limited role for IFN-a in aCML. In patients presenting with low platelet counts, the known platelet-lowering effect of INF-a treatment may further aggravate thrombocytopenia.

Recent availability of pegylated IFN, a pharmacologic formulation providing a slow release of the agent with weekly administration, has renewed interest in reexam-ining the efficacy of IFN-a in MPD, including aCML. In the absence of better choices, this treatment may be offered as an investigational alternative to hydroxyurea or for patients failing hydroxyurea therapy.

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