Current best options for first line treatment of chronic phase chronic myeloid leukemia

Hehlmann and S. Saußele

III Medizinische Klinik, Medizinische Fakultät Mannheim Universität Heidelberg, Mannheim, Germany

e-mail: sekretariat.hehlmann@medma.uni-heidelberg.de

Accepted September 16, 2013.


ABSTRACT

Treatment with tyrosine kinase inhibitors (TKI) has remarkably improved prognosis of chronic myeloid leukemia (CML). The 2013 ELN management recommendations recommend imatinib, dasatinib and nilotinib equally for first line treatment of CML and define new response levels.

Nilotinib and dasatinib induce responses faster than imatinib 400 mg. Faster responses are also observed with dose optimized imatinib 800 mg. Off-target effects of 2nd generation TKI are of concern. No serious long term side effects have been reported with imatinib. The impact of early response on survival has led to new definitions of optimal response and failure. More than 10 % residual BCR-ABL transcripts according to the international scale (IS) or more than 35 % Ph positive metaphases at 6 months are defined as failure and an indication for a change of treatment. The limitations of this definition are discussed. Optimization of TKI treatment to achieve deep and durable molecular responses provides a perspective for treatment discontinuation and cure of CML.


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