Research work · 2009
Chronic Myelogenous Leukemia
Susan Mary O'Brien, Ellin Berman, Hossein Borghaei, Daniel J. DeAngelo, Marcel P. Devetten, Steven Michael Devine, Harry Paul Erba, Jason R. Gotlib, Madan Jagasia, Joseph O. Moore, Tariq I. Mughal, Javier A. Pinilla-Ibarz, Jerald P. Radich, Neil P. Shah, Paul J. Shami, Benjamin D. Smith, DS Snyder, Martin S. Tallman, Moshe Talpaz, Meir Wetzler
Journal of the National Comprehensive Cancer Network
Abstract
Chronic Myelogenous Leukemia Version 2:2010Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial.Participation in clinical trials is especially encouraged.All recommendations are category 2A unless otherwise noted.WORKUP a Chronic phase adult CML Ph negative and BCR-ABL negative 1 Ph positive or BCR-ABL positive 1 H&P CBC, platelets Chemistry profile Consider HLA testing Bone marrow aspirate and biopsy Morphologic review Percent blasts Percent basophils Cytogenetics, FISH, QPCR b c Evaluate for other diseases (not CML) Discussion of treatment options including: Imatinib Role of HSCT Clinical trial d,e f,g Imatinib, 400 mg (category 1) h,i,j PRIMARY TREATMENT a See Monitoring for Patients Receiving Tyrosine Kinase Inhibitor therapy (page 992).c See text for further discussion regarding the role of FISH in the initial workup of patients with CML.d There is 7 year follow-up data which shows clear evidence of excellent survival benefit with imatinib.See text for additional information.e For patients with symptomatic leukocytosis or thrombocytosis, see Supportive Care Strategies (page 992).f HSCT = hematopoietic stem cell transplantation.Refers to a matched related and unrelated allogeneic transplant.HLA testing should be performed if considering HSCT.g Indications and outcomes of related and unrelated transplant are age, donor type, and transplant center dependent.Nonmyeloablative transplant is under investigation and should be performed only in the context of a clinical trial.h There are data suggesting a faster time to MMR with a higher dose of imatinib but whether this is an important end point in long-term outcome is unknown.Cortes J, Baccarani M, Guilhot F, et al.A phase III, randomized, open-label study of 400 mg versus 800 mg of imatinib mesylate in patients with newly diagnosed, previously untreated chronic myeloid leukemia in chronic phase using molecular endpoints: 1 year results of TOPS study [abstract].Blood 2008;112:Abstract 335.i See Management of Imatinib Toxicity (page 993).j Rare patients unable to tolerate imatinib, dasatinib, or nilotinib should consider IFN/PEG-IFN or clinical trial.b Bone marrow is preferable for the initial workup, not only to provide morphologic review, but also to detect chromosomal abnormalities that are not detectable on peripheral blood FISH.