British Society for Haematology Guideline for Management of CML
Posted: Tuesday, September 8, 2020
The British Society for Haematology has published a guideline in the British Journal of Haematology for the diagnosis and management of chronic myeloid leukemia (CML). “The management of CML has seen considerable change in the last several years,” stated Mhairi Copland, PhD, MB BChir, of the University of Glasgow, Scotland, and colleagues. The guidelines—created by performing a literature review of pertinent studies through January 2018—are intended to provide clinicians with “clear guidance” on treating and caring for patients with CML.
At diagnosis, the guideline recommends performing a full karyotype analysis and establishing the fusion type for molecular monitoring to guide future management. Imatinib is the preferred first-line treatment for the majority of patients with CML in chronic phase, although second-generation tyrosine kinase inhibitors (TKIs) may be considered for subsets of patients, such as those with a high or intermediate EUTOS Long-Term Survival (ELTS) or Sokal score.
Molecular monitoring should be performed by a reverse transcriptase quantitative polymerase chain reaction assay that can detect disease levels down to MR4.5. The guideline indicates monitoring should be done every 3 months until the achievement of a stable major molecular response and thereafter at 3- to 6-month intervals.
For patients whose disease fails to respond to first-line therapy, the panel recommends consideration for switching to an alternative TKI; the choice of second-line therapy should be guided by BCR-ABL1 kinase domain mutational status. For patients without specific mutations, comorbidities and the known side-effect profiles of the second-generation TKIs should inform the treatment choice.
The guideline notes that most side effects of TKIs can be managed with dose interruption or reduction and slow titration back to a dose that maintains major molecular response. In addition to monitoring blood pressure regularly, complaints of breathlessness should be investigated thoroughly.
Disclosure: For full disclosures of the study authors, visit onlinelibrary.wiley.com.