European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia

• Published in: Leukemia Vol. 34; no. 4; pp. 966 - 984
• Main Authors: Hochhaus, A., Baccarani, M., Silver, R. T., Schiffer, C., Apperley, J. F., Cervantes, F., Clark, R. E., Cortes, J. E., Deininger, M. W., Guilhot, F., Hjorth-Hansen, H., Hughes, T. P., Janssen, J. J. W. M., Kantarjian, H. M., Kim, D. W., Larson, R. A., Lipton, J. H., Mahon, F. X., Mayer, J., Nicolini, F., Niederwieser, D., Pane, F., Radich, J. P., Rea, D., Richter, J., Rosti, G., Rousselot, P., Saglio, G., Saußele, S., Soverini, S., Steegmann, J. L., Turkina, A., Zaritskey, A., Hehlmann, R.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2020; Nature Publishing Group; Springer Nature
• Subjects: 631/67/1059/602; 692/699/1541/1990/283/1896; 96; 96/95; Aniline Compounds - therapeutic use; Antineoplastic Agents - therapeutic use; Cancer; Cancer Research; Chronic myeloid leukemia; Clinical Decision-Making; Clinical Medicine; Consensus Development Conferences as Topic; Critical Care Medicine; Dasatinib - therapeutic use; Diagnosis; Disease Management; Dosage and administration; Drug therapy; Enzyme inhibitors; Fusion Proteins, bcr-abl - antagonists & inhibitors; Fusion Proteins, bcr-abl - genetics; Fusion Proteins, bcr-abl - metabolism; Gene Expression; Hematologi; Hematology; Humans; Imatinib; Imatinib Mesylate - therapeutic use; Inhibitor drugs; Intensive; Internal Medicine; Intolerance; Kinases; Klinisk medicin; Leukemia; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - diagnosis; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - genetics; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - mortality; Life expectancy; Life Expectancy - trends; Life Sciences; Life span; Medical and Health Sciences; Medical societies; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Monitoring, Physiologic; Myeloid leukemia; Nitriles - therapeutic use; Oncology; Patient outcomes; Polymerase chain reaction; Pregnancy; Protein Kinase Inhibitors - therapeutic use; Protein-tyrosine kinase; Pyrimidines - therapeutic use; Quality of Life; Quinolines - therapeutic use; Remission; Review; Review Article; Survival Analysis; Targeted cancer therapy; Transplantation; Tyrosine; Italy
• ISSN: 0887-6924; 1476-5551; 1476-5551
• DOI: 10.1038/s41375-020-0776-2

The therapeutic landscape of chronic myeloid leukemia (CML) has profoundly changed over the past 7 years. Most patients with chronic phase (CP) now have a normal life expectancy. Another goal is achieving a stable deep molecular response (DMR) and discontinuing medication for treatment-free remission (TFR). The European LeukemiaNet convened an expert panel to critically evaluate and update the evidence to achieve these goals since its previous recommendations. First-line treatment is a tyrosine kinase inhibitor (TKI; imatinib brand or generic, dasatinib, nilotinib, and bosutinib are available first-line). Generic imatinib is the cost-effective initial treatment in CP. Various contraindications and side-effects of all TKIs should be considered. Patient risk status at diagnosis should be assessed with the new EUTOS long-term survival (ELTS)-score. Monitoring of response should be done by quantitative polymerase chain reaction whenever possible. A change of treatment is recommended when intolerance cannot be ameliorated or when molecular milestones are not reached. Greater than 10% BCR-ABL1 at 3 months indicates treatment failure when confirmed. Allogeneic transplantation continues to be a therapeutic option particularly for advanced phase CML. TKI treatment should be withheld during pregnancy. Treatment discontinuation may be considered in patients with durable DMR with the goal of achieving TFR.