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.
European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013
Posted 03 February 2014 - 11:29 AM
Overall a useful report on ELN CML Guidelines. Worth reading since it shows the current state of TKI treatment thinking.
Here are a few of my inputs:
It gets rid of the outdated and useless Sokal and Hasford risk scores for CML. Good. They were pre-TKI and very inaccurate. But the substitute is also not very useful since it only considers spleen size and basophil count. Personally, I would just use Accelerated and Blast Phase to determine risk.
ELN redefines TKI treatment success in and overly aggressive way. Only 3 categories "optimal, warning, and failure" levels. What about "average" or "acceptable" or whatever? Wanting MMR by 12 months or the patient is in a "warning" mode. This only leads to Onc Anxiety and patient disappointment, leading to poor decision making. Very disappointing to see this. Most patients are average. Why tell them they are in "warning" category? Puts undue stress on patients. Ridiculous.
Pregnancy and TKI treatment discontinuation: ELN says "....fertile women who may have achieved an optimal response...when the optimal response is stable for at least 2 years, TKI discontinuation with or without the use of rIFN?, can be considered, after informed consent and with very frequent molecular monitoring." Optimal response for this purpose appears to be at least MMR for a minimum of 2 years (but the paragraph might imply 4.5 log reduction instead of just MMR).
Overall worth reading. But very disappointing to see the overly aggressive redefining of treatment success.
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