European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia
First‑line treatment is a tyrosine kinase inhibitor (TKI; imatinib brand or generic, dasatinib, nilotinib, and bosutinib are available first‑line).
The therapeutic landscape of chronic myeloid leukemia (CML) has profoundly changed over the past 7 years. Most patients with chronic phase (CP) now have a normal life expectancy. Another goal is achieving a stable deep molecular response (DMR) and discontinuing medication for treatment‑free remission (TFR). The European LeukemiaNet convened an expert panel to critically evaluate and update the evidence to achieve these goals since its previous recommendations. First‑line treatment is a tyrosine kinase inhibitor (TKI; imatinib brand or generic, dasatinib, nilotinib, and bosutinib are available first‑line). Generic imatinib is the cost‑effective initial treatment in CP. Various contraindications and side‑effects of all TKIs should be considered. Patient risk status at diagnosis should be assessed with the new EUTOS long‑term survival (ELTS)‑score. Monitoring of response should be done by quantitative polymerase chain reaction whenever possible. A change of treatment is recommended when intolerance cannot be ameliorated or when molecular milestones are not reached. Greater than 10% BCR‑ABL1 at 3 months indicates treatment failure when confirmed. Allogeneic transplantation continues to be a therapeutic option particularly for advanced phase CML. TKI treatment should be withheld during pregnancy. Treatment discontinuation may be considered in patients with durable DMR with the goal of achieving TFR.
CML is a chronic disease that can be managed with targeted therapy, but the choice and sequencing of tyrosine kinase inhibitors (TKIs) is critical for maximizing survival, minimizing toxicity, and achieving treatment‑free remission. The European LeukemiaNet 2020 recommendations provide clinicians with evidence‑based guidance on which first‑line TKIs to use, how to monitor response, and when to switch therapies or consider discontinuation. This enables individualized patient care and supports the overarching goal of normal life expectancy for the majority of patients.
Evidence level: Feltételezés / hírjelzés. Nincs önálló tudományos bizonyíték.
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