This NCCN QUICK GUIDE tm sheet summarises key points from the complete
NCCN Guidelines for Patients®: Chronic Myeloid Leukemia. These guidelines explain
which tests and treatments are recommended by experts in cancer. To view and download the guidelines, visit NCCN.org/patients.
https://www.nccn.org/patients/guidelines/content/PDF/nccnquickguide-cml-...
Full NCCN Guidelines for CML 2020:
Several papers authored by international experts have proposed recommendations on the management of BCR-ABL1+ chronic myeloid leukaemia (CML). Following these recommendations, survival of CML patients has become very close to normal. The next, ambitious, step is to bring as many patients as possible into a condition of treatment-free remission (TFR).
https://ashpublications.org/bloodadvances/article/3/24/4280/429987/Manag...
Atypical CML, or aCML is a form of CML where there is no expression of the BCR-Abl fusion gene. This has made it difficult to treat.
https://www.targetedonc.com/news/ruxolitinib-shows-noteworthy-responses-...
Patients who maintained MR4.5 at 24 months of consolidation therapy proceeded to discontinuation of nilotinib. The study enrolled 149 patients; 112 patients proceeded to consolidation therapy with nilotinib; 90 patients maintained MR4.5 with consolidation therapy, and 87 proceeded to discontinuation of nilotinib. The treatment-free remission (TFR) (MR4.5) rate at both 1 and 3 years after discontinuation of nilotinib was the same, at 60.9% (90% CI 51.6–69.7).
19 September 2019
We demonstrate that combining asciminib with ATP site TKIs enhances target inhibition and suppression of resistant outgrowth in Ph+ clinical isolates and cell lines. Inclusion of asciminib restores ponatinib's effectiveness against currently untreatable compound mutants at clinically achievable concentrations. Our findings support combining asciminib with ponatinib as a treatment strategy for this molecularly defined group of patients.
Dasatinib, a potent Bcr‐Abl tyrosine kinase inhibitor, is approved for the treatment of chronic‐phase chronic myeloid leukemia (CML‐CP) in the frontline and salvage settings. Notable side effects include pleural effusions and myelosuppression. Dasatinib at 50 mg daily has previously been reported to be active and better tolerated than the approved 100‐mg daily dose. The aim of this study was to update the long‐term follow‐up results of dasatinib at 50 mg daily as frontline therapy for CML‐CP. ClinicalTrials.gov (NCT02689440)
Chronic myeloid leukaemia is driven by a hybrid gene, BCR-ABL1, that codes for a leukemogenic tyrosine kinase (TK) protein of 210 KDa (p210BCR-ABL1). Resistance to TK inhibitor (TKI) therapy occurs in relatively few patients, no more than 10%, while persistence of minimal residual disease during TKI therapy occurs in the great majority of patients. Leukemia vol 33, pgs 2358–2364 (2019
BACKGROUND: All studies of treatment-free remission (TFR) in patients with chronic myeloid leukaemia have discontinued tyrosine kinase inhibitor (TKI) treatment abruptly and have focussed on patients with stable MR4 (BCR-ABL to ABL ratio ≤0·01%). We aimed to examine the effects of gradual treatment withdrawal and whether TFR is feasible for patients with a less deep but stable remission.
BACKGROUND
Marlise R. Luskin Published online: 23 Jul 2018
As CML is now a controllable, chronic condition for most patients, focus turns to the impact of the disease and TKI treatment on quality of life. For young patients with CML, the opportunity to raise a family is a frequent goal. However, the TKIs that have dramatically improved CML outcomes are teratogenic, meaning that women with CML who want to conceive or who become pregnant must stop their TKI which may, in turn, comprise treatment of the CML.