Dr. Sunil Gandhi, Cancer & Blood Disease, 09/11/12

Mrs. Smith is a 75-year-old white lady who went to see her family physician for a routine visit. Her doctor ordered a blood test including a complete blood count (CBC). It showed her WBC (white blood cell) was elevated. She was referred to me for further workup.

She had an outpatient bone marrow biopsy done. A bone marrow biopsy removes a small amount of bone and a small amount of fluid and cells from inside the bone — bone marrow.

This can be painful for one to two minutes, so we do it under sedation in our office. An expert anesthesia doctor administers sedation. Thus, the procedure is painless.

My patient was found to have an uncommon leukemia called CML (Chronic Myeloid Leukemia). Ordinarily, the body controls the number of WBC very tightly.

In CML, the abnormal BCR-ABL enzyme is like a switch that is stuck in the “on” position. It keeps stimulating the white blood cells to grow and multiply. Also, the platelets (cells that help the blood to clot) may increase and the red blood cells, which carry oxygen, may decrease.

CML used to be uniformly fatal until 2000. Now, new drugs are available which can practically normalize the lifespan of CML patients. These drugs are pill. Unfortunately, not all patients can tolerate them well. Only about 5,400 new patients of CML are diagnosed each year in the USA.

My patient was started on a drug called Sprycel and her CML responded very well. She went into complete remission. Unfortunately, she developed pleural effusion — fluid around the lung; a common side effect of Sprycel.

Now, the FDA approved a new drug — bosutinib (Bosulif). This drug is once-a-day pill. It is usually well tolerated. Adverse events were similar to what has previously been reported for this agent, with the most common being diarrhea, nausea, vomiting, rash, headache and fatigue. These were usually mild, and most patients tolerated it well.

This is a new advance in this rare leukemia. It may help many patients who could not tolerate or did not respond to the other drugs. Advances like this help us in the fight against cancer. My patient may benefit from this drug.

Dr. Sunil Gandhi is a hematologist and oncologist. He is volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email sgandhi@tampabay.rr.com or call 352-746-0707.