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    Management of Chronic Myelogenous Leukemia (CML)

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    Management of Chronic Myelogenous Leukemia (CML)

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    amelina
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    Edition: ENGLISH DEUTSCH ESPAOL FRANAIS PORTUGUS


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    NEWS & PERSPECTIVE DRUGS & DISEASES CME &


    EDUCATION ACADEMY VIDEO
    Drugs & Diseases > Cancer Guides

    Chronic Myelogenous Leukemia (CML)


    Guidelines
    Updated: Dec 23, 2016
    Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD more...

    Management of Chronic Myelogenous Leukemia (CML)


    Guidelines for the management of chronic myelogenous leukemia (CML) have been
    issued by the following organizations:
    National Comprehensive Cancer Network (NCCN) [1]
    European Society of Medical Oncology (ESMO) [2]
    European LeukemiaNet (ELN) [3]
    For chronic-phase CML, all the guidelines recommend the following:
    Any of three tyrosine kinase inhibitors (TKIs) (imatinib, nilotinib, or dasatinib)
    are the first-line treatment for CML
    In case of intolerance, patients can be switched to another TKI or bosutinib
    All three TKIs can be used as second-line treatment; doses may differ in the
    second- line setting, depending on the agent chosen
    Hematopoietic stem cell transplantation (HSCT) should be considered in the case
    of failure of two TKIs
    For accelerated-phase CML, all the guidelines recommend the following:
    TKI (imatinib, nilotinib, dasatinib or bosutinib).
    Choice of TKI is based on prior therapy and/or BCR-ABL kinase domain
    mutation status
    Recommended doses of imatinib, nilotinib, and dasatinib are higher for
    accelerated phase than for chronic phase
    If resistance and/or intolerance to two or more TKIs occurs, consider
    omacetaxine
    Consider HSCT, based on treatment response and patient age
    For blast-phase CML, all the guidelines recommend the following:
    HSCT, preferably after response to induction therapy
    Patients in lymphoid blast phase can be treated with acute lymphoblastic
    leukemia (ALL) induction chemotherapy regimens in combination with a TKI
    Patients in myeloid blast crisis can be treated with acute myeloid leukemia
    (AML) induction chemotherapy regimens in combination with a TKI
    Monitoring
    National Comprehensive Cancer Network (NCCN), European LeukemiaNet (ELN),
    and European Society of Medical Oncology (ESMO) guidelines recommend the
    following tests for monitoring response to tyrosine kinase inhibitor (TKI) therapy:
    Bone marrow cytogenetics
    Quantitative reverse transcription polymerase chain reaction (QPCR)
    The three guidelines vary in their recommendations regarding response to first-line
    treatment, as outlined below.
    NCCN Recommendations
    The desired responses to first-line treatment are as follows:
    3 months: BCR-ABL1 transcripts 10% by QPCR or partial cytogenetic
    response (PCyR) on bone marrow cytogenetics
    6 months: BCR-ABL1 transcripts 10% by QPCR or PCyR on bone marrow
    cytogenetics
    12 months: Complete cytogenetic response (CCyR) on bone marrow
    cytogenetics (if neither CCyR nor major molecular response [MMR] has been
    previously achieved)
    18 months: CCyR on bone marrow cytogenetics (if not in MMR and lack of
    CCyR at 12 months)
    Any time: Stable or improving MMR

    European LeukemiaNet
    The optimal responses to first-line treatment are as follows:
    3 months: Ph+35%, and/or BCR-ABL110%
    6 months: : PH+ 0%, and/or BCR-ABL1 < 1%
    12 months: BCR-ABL10.1%

    European Society of Medical Oncology (ESMO)


    The optimal responses to first-line treatment are as follows:
    3 months: Philadelphia chromosome positive (Ph+) 95%, or BCR-ABL< 10%
    6 months: Ph+ 35%, or BCR-ABL < 10%
    12 months: PH+ 0, or BCR-ABL 1%

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