With second-generation tyrosine kinase inhibitors available, should imatinib still be first-line treatment for patients with chronic myelogenous leukemia (CML)? Two experts debated the question here at the International Congress on Hematological Malignancies.
Mauro said the real questions in the debate are about early, meaningful response and overcoming resistance.
He offered three axioms for CML:
- This is not like treating an infection with antibiotics, where you 'save the big guns' for resistance if you need them";
- "You have one chance to do it right for chronic-phase CML"; and
- "Treating resistant CML is like a chess match, with sequential and now compound mutations coming like a sequence of moves -- blast crisis is the check mate."