European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013

Abstract

Abstract Advances in chronic myeloid leukemia treatment, particularly regarding tyrosine kinase inhibitors, mandate regular updating of concepts and management. A European LeukemiaNet expert panel reviewed prior and new studies to update recommendations made in 2009. We recommend as initial treatment imatinib, nilotinib, or dasatinib. Response is assessed with standardized real quantitative polymerase chain reaction and/or cytogenetics at 3, 6, and 12 months. BCR-ABL1 transcript levels ≤10% at 3 months, <1% at 6 months, and ≤0.1% from 12 months onward define optimal response, whereas >10% at 6 months and >1% from 12 months onward define failure, mandating a change in treatment. Similarly, partial cytogenetic response (PCyR) at 3 months and complete cytogenetic response (CCyR) from 6 months onward define optimal response, whereas no CyR (Philadelphia chromosome–positive [Ph+] >95%) at 3 months, less than PCyR at 6 months, and less than CCyR from 12 months onward define failure. Between optimal and failure, there is an intermediate warning zone requiring more frequent monitoring. Similar definitions are provided for response to second-line therapy. Specific recommendations are made for patients in the accelerated and blastic phases, and for allogeneic stem cell transplantation. Optimal responders should continue therapy indefinitely, with careful surveillance, or they can be enrolled in controlled studies of treatment discontinuation once a deeper molecular response is achieved.

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Affiliated Institutions

• University of Utah US
• Royal Liverpool University Hospital GB
• University Hospital Heidelberg DE
• Huntsman Cancer Institute US
• Université de Poitiers FR
• South Australia Pathology AU
• University of Liverpool GB
• University of Toronto CA
• The University of Texas MD Anderson Cancer Center US
• Norwegian University of Science and Technology
• University of Turin IT
• Université de Versailles Saint-Quentin-en-Yvelines FR
• Princess Margaret Cancer Centre CA
• Seoul St. Mary's Hospital KR
• Ceinge Biotecnologie Avanzate (Italy) IT
• University of Bologna IT
• The Barbara Ann Karmanos Cancer Institute US
• University of Chicago US
• Inserm FR
• Fred Hutch Cancer Center US
• The University of Adelaide AU
• Central European Institute of Technology CZ
• Uppsala University Hospital SE
• Heidelberg University US
• IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola IT
• Université de Bordeaux FR
• Imperial College London GB
• Jena University Hospital DE
• Universitat de Barcelona ES
• Catholic University of Korea KR
• Cornell University US
• Centre Hospitalier Universitaire de Bordeaux FR
• University Hospital Brno CZ
• Wayne State University US
• Central European Institute of Technology – Masaryk University CZ
• Heidelberg University DE
• Hospital Universitario de La Princesa ES

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