European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013

• Published in: Blood Vol. 122; no. 6; pp. 872 - 884
• Main Authors: Baccarani, Michele, Deininger, Michael W., Rosti, Gianantonio, Hochhaus, Andreas, Soverini, Simona, Apperley, Jane F., Cervantes, Francisco, Clark, Richard E., Cortes, Jorge E., Guilhot, François, Hjorth-Hansen, Henrik, Hughes, Timothy P., Kantarjian, Hagop M., Kim, Dong-Wook, Larson, Richard A., Lipton, Jeffrey H., Mahon, François-Xavier, Martinelli, Giovanni, Mayer, Jiri, Müller, Martin C., Niederwieser, Dietger, Pane, Fabrizio, Radich, Jerald P., Rousselot, Philippe, Saglio, Giuseppe, Saußele, Susanne, Schiffer, Charles, Silver, Richard, Simonsson, Bengt, Steegmann, Juan-Luis, Goldman, John M., Hehlmann, Rüdiger
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 08.08.2013; American Society of Hematology
• Subjects: Antineoplastic Agents - therapeutic use; Benzamides - therapeutic use; Dasatinib; Europe; Fusion Proteins, bcr-abl - metabolism; Human health and pathology; Humans; Imatinib Mesylate; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - therapy; Life Sciences; Piperazines - therapeutic use; Prognosis; Pyrimidines - therapeutic use; Randomized Controlled Trials as Topic; Review; Stem Cell Transplantation; Thiazoles - therapeutic use; Treatment Outcome; Europe; leukemia; dasatinib; nilotinib; myelocytic; second line treatment; imatinib mesylate; withdrawing treatment; cytogenetics; chronic; protein-tyrosine kinase inhibitor; polymerase chain reaction; allogeneic stem cell transplant
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood-2013-05-501569

Advances in chronic myeloid leukemia treatment, particularly regarding tyrosine kinase inhibitors, mandate regular updating of concepts and management. A European LeukemiaNet expert panel reviewed prior and new studies to update recommendations made in 2009. We recommend as initial treatment imatinib, nilotinib, or dasatinib. Response is assessed with standardized real quantitative polymerase chain reaction and/or cytogenetics at 3, 6, and 12 months. BCR-ABL1 transcript levels ≤10% at 3 months, <1% at 6 months, and ≤0.1% from 12 months onward define optimal response, whereas >10% at 6 months and >1% from 12 months onward define failure, mandating a change in treatment. Similarly, partial cytogenetic response (PCyR) at 3 months and complete cytogenetic response (CCyR) from 6 months onward define optimal response, whereas no CyR (Philadelphia chromosome–positive [Ph+] >95%) at 3 months, less than PCyR at 6 months, and less than CCyR from 12 months onward define failure. Between optimal and failure, there is an intermediate warning zone requiring more frequent monitoring. Similar definitions are provided for response to second-line therapy. Specific recommendations are made for patients in the accelerated and blastic phases, and for allogeneic stem cell transplantation. Optimal responders should continue therapy indefinitely, with careful surveillance, or they can be enrolled in controlled studies of treatment discontinuation once a deeper molecular response is achieved.