What are treatment guidelines for chronic-phase chronic myelogenous leukemia (CML)?

Updated: May 23, 2021
  • Author: Emmanuel C Besa, MD; Chief Editor: Sara J Grethlein, MD, FACP  more...
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For chronic-phase CML, treatment recommendations are as follows:

  • All of the guidelines recommend the tyrosine kinase inhibitors (TKIs) imatinib, nilotinib, or dasatinib as first-line treatment for CML; NCCN also includes bosutinib, and ESMO notes that other strategies include using higher doses of imatinib or combining a TKI with an additional agent, such as interferon-α.

  • All the guidelines agree that the selection of first-line TKI therapy should be based on the patient's risk score, ability to tolerate therapy, and comorbid conditions and the adverse effect profile of the TKI

  • In case of intolerance, patients can be switched to another TKI; ESMO and ELN list bosutinib as an option in this setting

  • All TKIs can be used as second-line treatment; doses may differ in the second- line setting, depending on the agent chosen

  • BCR-ABL kinase domain mutation analysis, evaluation of drug interactions, and compliance to therapy are recommended before the start of second-line TKI therapy.

  • Ponatinib is an option for patients with T315I mutation and for those with disease that has not responded to several TKIs.

  • Allogeneic hematopoietic stem cell transplantation (HSCT) should be considered in the case of failure of two TKIs

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