RT Book, Section
A1 Sasaki, Koji
A1 Jabbour, Elias
A1 Cortes, Jorge
A1 Kantarjian, Hagop
A2 Kantarjian, Hagop M.
A2 Wolff, Robert A.
A2 Rieber, Alyssa G.
SR Print(0)
ID 1190832182
T1 Chronic Myeloid Leukemia
T2 The MD Anderson Manual of Medical Oncology, 4e
YR 2022
FD 2022
PB McGraw Hill Education
PP New York, NY
SN 9781260467642
LK hemonc.mhmedical.com/content.aspx?aid=1190832182
RD 2024/04/24
AB KEY  CONCEPTSThe  survival  of  patients  with  chronic  myeloid  leukemia  (CML)  has  improved  significantly  since  the  advent  of  tyrosine  kinase  inhibitor  (TKI)  therapy.  With  the  availability  of  TKI  and  proper  management,  the  expected  survival  of  patients  with  chronic  phase  CML  (CML-CP)  is  approaching  that  of  the  general  population.Any  of  the  four  TKIs  approved  for  frontline  therapy  of  CML-CP  may  be  selected.  These  include  imatinib,  dasatinib,  nilotinib,  and  bosutinib.  Second-generation  TKIs  are  superior  to  imatinib  in  achieving  faster  and  deeper  responses  compared  with  imatinib,  but  survival  is  similar  because  of  the  availability  of  effective  TKI  salvage  therapies.Factors  considered  in  choosing  TKI  therapy  in  the  frontline  setting  include  patient  age,  comorbidities,  adverse  events  profile,  and  disease  risk  score,  as  well  as  the  TKI-associated  schedule  of  administration  and  cost.  Kinase  domain  mutation  profile  plays  no  role  in  selecting  an  initial  TKI  but  becomes  relevant  in  relapse.Most  TKIs  are  reasonably  well  tolerated  with  close  observation  and  supportive  care.  However,  each  TKI  therapy  has  a  distinct  toxicity  profile  that  should  be  considered  when  deciding  on  therapy.Second-  and  third-generation  TKIs  have  not  been  compared  head  to  head.  Mutational  analysis  is  required  after  failure  of  imatinib  or  second-generation  TKIs,  or  after  progression  to  accelerated  phase  CML  (CML-AP)  or  blastic  phase  (CML-BP).  Baseline  mutational  analysis  are  not  recommended  in  newly  diagnosed  CML-CP  because  it  does  not  help  predict  treatment  outcome.Allogeneic  stem  cell  transplant  should  be  considered  in  patients  who  progress  from  CML-CP  to  CML-AP/CML-BP  after  TKI  therapy  failure  and  who  fail  second-  or  third-generation  TKI  while  still  in  CML-CP.