Chronic myeloid leukaemia (CML) was recognized in the 1970s by Janet Rowley to be a genetically simple malignancy; resulting as a consequence of a balanced translocation between chromosome 9 and 22. This provided vital insights into the molecular aberration, in the 1990s, which ushered in the current ‘precision medicine’ era, not only for patients of CML, but for cancers in general. As a result, today, a personalized treatment algorithm is available for all newly diagnosed patients with CML. Treatment involves a choice of three first-line orally administered tyrosine kinase inhibitors (TKIs) and two effective next-line TKIs that should be used based on risk stratification, comorbidities, the side effects profile, and the BCR-ABL1 genotype. Regardless of the initial choice of TKI, the vast majority of patients achieve a durable complete cytogenetic remission, with a lifespan approaching that of the general population. In most instances the medication must be continued indefinitely, and a principal challenge now, is to develop strategies to stop TKIs safely and effectively. Challenges remain in how to achieve optimal monitoring of patients with CML on treatment and in achieving a better understanding of the mechanisms and treatment of patients with advanced phase disease. This chapter addresses these questions as well as the concomitant topical issues in CML.
Excision of intra-dural dorsal spine meningioma with intra-operative neuromonitoring in a patient with post-pneumonectomy status- an anaesthetic challenge
