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NCCN guidelines, are they still the gold standard?

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#1 LLawrence


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Posted 13 July 2013 - 07:48 AM

I am approaching a year on treatment in August and have responded well (CHR in 1.5 mos, MMR in 3 mos).  I am reviewing my treatment to date and note that my monitoring is different than the NCCN guidelines.  My oncologist specializes in AML and CML and is very data driven in her treatment plans.  I will ask at my my next appointment, but I note that I have primarily been monitored by PCR and cbc.  I note that the NCCN guidelines were last updated in 2011.  The question is whether my monitoring is more current than the guidelines?  I have responded well enough (so far) that the question may be moot.

It should be noted that I have been verbal about my hope to never have another bone marrow biopsy/aspirate, so I may have skewed the process. 



#2 Trey


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Posted 13 July 2013 - 09:43 AM

The CML NCCN Guidelines are due to have an update very soon in mid-2013, hopefully in the next couple months. 

Those who respond quickly as you have fall into a gray area regarding frequency and types of monitoring.  The NCCN Guidelines do not really deal with MMR as a goal, and rely on CCyR and time as the determining factors.  NCCN goes from CCyR straight to CMR (PCRU) as goals, so there is no actual relief after MMR in the Guidelines.  This is a shortcoming.  But leading CML Oncs recognize that after MMR the monitoring can be decreased, generally to 6 months.  Also long term CCyR can lead to decreased monitoring.  However, when someone achieves MMR in under 1 year, and maybe under 18 months since diagnosis, the Onc may be a bit more cautious and stick with a 3 month PCR schedule.  I agree with this, since if resistance is going to appear it will most likely occur during this timeframe (up to 2 years). 

Regarding another BMB at 1 year, leading Oncs will say that after MMR it is not necessary unless there were high risk factors seen at diagnosis.

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