European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia

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 remissio...

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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
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Abstract	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.
AbstractList	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. 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.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.
Audience	Academic
Author	Apperley, J. F. Turkina, A. Schiffer, C. Kantarjian, H. M. Niederwieser, D. Radich, J. P. Rea, D. Baccarani, M. Deininger, M. W. Mahon, F. X. Zaritskey, A. Pane, F. Hughes, T. P. Kim, D. W. Hehlmann, R. Saglio, G. Clark, R. E. Silver, R. T. Nicolini, F. Richter, J. Hjorth-Hansen, H. Steegmann, J. L. Mayer, J. Janssen, J. J. W. M. Soverini, S. Rosti, G. Rousselot, P. Guilhot, F. Lipton, J. H. Larson, R. A. Cortes, J. E. Cervantes, F. Hochhaus, A. Saußele, S.
Author_xml	– sequence: 1 givenname: A. surname: Hochhaus fullname: Hochhaus, A. email: andreas.hochhaus@med.uni-jena.de organization: Klinik für Innere Medizin II, Universitätsklinikum – sequence: 2 givenname: M. surname: Baccarani fullname: Baccarani, M. organization: Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna – sequence: 3 givenname: R. T. surname: Silver fullname: Silver, R. T. organization: Weill Cornell Medical College – sequence: 4 givenname: C. surname: Schiffer fullname: Schiffer, C. organization: Karmanos Cancer Center – sequence: 5 givenname: J. F. surname: Apperley fullname: Apperley, J. F. organization: Hammersmith Hospital, Imperial College – sequence: 6 givenname: F. surname: Cervantes fullname: Cervantes, F. organization: Hospital Clinic IDIBAPS – sequence: 7 givenname: R. E. surname: Clark fullname: Clark, R. E. organization: Department of Molecular & Clinical Cancer Medicine, University of Liverpool – sequence: 8 givenname: J. E. surname: Cortes fullname: Cortes, J. E. organization: Georgia Cancer Center, Augusta University – sequence: 9 givenname: M. W. surname: Deininger fullname: Deininger, M. W. organization: Huntsman Cancer Center Salt Lake City – sequence: 10 givenname: F. surname: Guilhot fullname: Guilhot, F. organization: Centre Hospitalier Universitaire de Poitiers – sequence: 11 givenname: H. surname: Hjorth-Hansen fullname: Hjorth-Hansen, H. organization: Norwegian University of Science and Technology – sequence: 12 givenname: T. P. surname: Hughes fullname: Hughes, T. P. organization: South Australian Health and Medical Research Institute – sequence: 13 givenname: J. J. W. M. surname: Janssen fullname: Janssen, J. J. W. M. organization: Amsterdam University Medical Center, VUMC – sequence: 14 givenname: H. M. surname: Kantarjian fullname: Kantarjian, H. M. organization: MD Anderson Cancer Center – sequence: 15 givenname: D. W. surname: Kim fullname: Kim, D. W. organization: St. Mary´s Hematology Hospital, The Catholic University – sequence: 16 givenname: R. A. surname: Larson fullname: Larson, R. A. organization: University of Chicago – sequence: 17 givenname: J. H. surname: Lipton fullname: Lipton, J. H. organization: University of Toronto – sequence: 18 givenname: F. X. surname: Mahon fullname: Mahon, F. X. organization: Institut Bergonie, Université de Bordeaux – sequence: 19 givenname: J. surname: Mayer fullname: Mayer, J. organization: Department of Internal Medicine, Masaryk University Hospital – sequence: 20 givenname: F. surname: Nicolini fullname: Nicolini, F. organization: Centre Léon Bérard – sequence: 21 givenname: D. surname: Niederwieser fullname: Niederwieser, D. organization: Universitätsklinikum – sequence: 22 givenname: F. surname: Pane fullname: Pane, F. organization: Department Clinical Medicine and Surgery, University Federico Secondo – sequence: 23 givenname: J. P. surname: Radich fullname: Radich, J. P. organization: Fred Hutchinson Cancer Center – sequence: 24 givenname: D. surname: Rea fullname: Rea, D. organization: Hôpital St. Louis – sequence: 25 givenname: J. surname: Richter fullname: Richter, J. organization: University of Lund – sequence: 26 givenname: G. surname: Rosti fullname: Rosti, G. organization: Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna – sequence: 27 givenname: P. surname: Rousselot fullname: Rousselot, P. organization: Centre Hospitalier de Versailles, University of Versailles Saint-Quentin-en-Yvelines – sequence: 28 givenname: G. surname: Saglio fullname: Saglio, G. organization: University of Turin – sequence: 29 givenname: S. surname: Saußele fullname: Saußele, S. organization: III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg – sequence: 30 givenname: S. surname: Soverini fullname: Soverini, S. organization: Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna – sequence: 31 givenname: J. L. surname: Steegmann fullname: Steegmann, J. L. organization: Hospital de la Princesa – sequence: 32 givenname: A. surname: Turkina fullname: Turkina, A. organization: National Research Center for Hematology – sequence: 33 givenname: A. surname: Zaritskey fullname: Zaritskey, A. organization: Almazov National Research Centre – sequence: 34 givenname: R. surname: Hehlmann fullname: Hehlmann, R. email: hehlmann.eln@gmail.com organization: III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, ELN Foundation
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/32127639$$D View this record in MEDLINE/PubMed https://hal.science/hal-03228140$$DView record in HAL https://lup.lub.lu.se/record/037eafe7-8594-4bfc-9053-9a8ff83a509e$$DView record from Swedish Publication Index oai:portal.research.lu.se:publications/037eafe7-8594-4bfc-9053-9a8ff83a509e$$DView record from Swedish Publication Index
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CorporateAuthor	Profile areas and other strong research environments Lunds universitet Department of Laboratory Medicine Lund University Division of Molecular Medicine and Gene Therapy Institutionen för laboratoriemedicin StemTherapy: National Initiative on Stem Cells for Regenerative Therapy Strategiska forskningsområden (SFO) Faculty of Medicine Strategic research areas (SRA) Avdelningen för molekylärmedicin och genterapi Medicinska fakulteten Profilområden och andra starka forskningsmiljöer
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Snippet	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...
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SubjectTerms	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
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Title	European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia
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