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Curr Hematol Malig Rep. 2019 Nov 7. doi: 10.1007/s11899-019-00550-8. [Epub ahead of print]

Early Management of CML.

Shanmuganathan N1,2,3,4,5, Hughes TP6,7,8.

Author information

1
Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia. naranie.shanmuganathan@sa.gov.au.
2
School of Medicine, University of Adelaide, Adelaide, South Australia, Australia. naranie.shanmuganathan@sa.gov.au.
3
Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, South Australia, Australia. naranie.shanmuganathan@sa.gov.au.
4
Centre for Cancer Biology, SA Pathology, Frome Road, Adelaide, South Australia, Australia. naranie.shanmuganathan@sa.gov.au.
5
School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. naranie.shanmuganathan@sa.gov.au.
6
Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
7
School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
8
Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, South Australia, Australia.

Abstract

PURPOSE OF REVIEW:

The marked improvement in clinical outcomes for patients with chronic myeloid leukaemia (CML) can be solely attributed to the introduction of targeted therapies against the fusion oncoprotein, BCR-ABL1. However, patient responses, although generally positive, remain heterogenous. Careful drug selection, ensuring the optimal TKI, is chosen for each patient and involves a complex decision process which incorporates consideration of numerous factors.

RECENT FINDINGS:

For some patients, with disease characteristics that indicate adverse intrinsic disease biology, more potent BCR-ABL1 inhibition is often appropriate, whereas other patients with major co-morbidities will benefit from a less aggressive approach to avoid life-shortening toxicities. For the vast majority of patients, the long-term goal of therapy will be the achievement of a deep molecular response and subsequent treatment-free remission and this consideration will play a large part in the drug selection process. We explore early management of CML, from the first presentation through to frontline therapy selection.

KEYWORDS:

Deep molecular responses; Drug toxicity; TKI; Treatment-free remission

PMID:
31701368
DOI:
10.1007/s11899-019-00550-8

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