Chronic Myeloid Leukaemia Treatment in Evolution

Moshe Talpaz, MD.

Key Concepts:

This educational activity is designed to provide a rapid review of essential practice relevant issues to quickly update busy clinicians

on recent data affecting the management of patients with chronic myeloid leukaemia (CML).

An interactive clinical vignette using a specific patient example has been incorporated into the discussion to illustrate a key point relevant

to today's clinic.

* Extended follow up of 2 pivotal trials separately evaluating the more potent 2nd generation TKIs in the first line setting,

demonstrates lower rates of transformation to accelerated phase or blast crisis compared with imatinib, an important goal

due to the dismal prognosis following transformation.

* Patient characteristics such as heart disease and gastrointestinal problems are critical to the choice of 2nd generations TKIs,

with nilotinib being preferred in the former and dasatinib being preferred in the latter.

* Bosutinib, an experimental TKI, showes modestly improved efficacy with more toxicity compared with imatinib as first line

therapy for chronic phase CML.

* Bostunib is approximately as active as nilotinib and dasatinib as 2nd line treatment, with activity in some Bcr-Abl mutations

resistant to these two agents.

* Ponatinib, another experimental TKI, produced high rates of major cytogenetic responses across subgroups of heavily

pre-treated patients with CML, including those with the T315i mutation.

* Future treatment goals include targeting CML stem cells, which are insensitive to TKIs

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