Welcome to The Medical Pipeline (TMP). The Medical Pipeline features topics that put you at the forefront of device, diagnostic, and drug research and development. Our feature report focuses on leukemia.

The outcomes of patients with chronic myelogenous leukemia (CML) improved dramatically when imatinib was approved by the U.S. Food and Drug Administration. Subsequently, newer agents in the same therapeutic class have been approved, and early clinical studies suggest that they may become the new standard of care.

Much encouraging research activity is occurring for new molecules for all types of leukemia. Investigational kinase inhibitors, such as bosutinib, seemingly will challenge imatinib's preeminent role in CML. The multitargeted kinase inhibitor midostaurin offers promise for treating acute myelogenous leukemia. The new monoclonal antibody, GA101, may have greater activity than that of rituximab in acute lymphocytic leukemia. Other experimental agents creating a buzz include oblimersen, an antisense oligonucleotide; histamine dihydrochloride, an immunotherapeutic agent; and amonafide, which induces apoptosis by interfering with deoxyribonucleic acid (DNA) synthesis. Omacetaxine is a first-in-class cetaxine that may be beneficial in patients with CML-resistant disease. There is also a liposomal vincristine sulfate product that has enhanced tumor activity compared with the currently available vincristine sulfate.

Improved utilization of practice guidelines for the leukemias will be crucial, according to our thought leaders. Coupled with this will be benefit design structures to optimize the value obtained for the anticipated increased costs of these new options. The budgetary impact of these new agents may be mitigated by advances in predictive molecular markers, which could have a dramatic effect on how we can pay for these promising new therapies.