JCO Early Release, published online ahead of print Nov 2 2009
Journal of Clinical Oncology, 10.1200/JCO.2009.25.0779
Received July 13, 2009
Accepted August 27, 2009
Chronic Myeloid Leukemia: An Update of Concepts and Management Recommendations of European LeukemiaNet
Michele Baccarani,* Jorge Cortes, Fabrizio Pane, Dietger Niederwieser, Giuseppe Saglio, Jane Apperley, Francisco Cervantes, Michael Deininger, Alois Gratwohl, François Guilhot, Andreas Hochhaus, Mary Horowitz, Timothy Hughes, Hagop Kantarjian, Richard Larson, Jerald Radich, Bengt Simonsson, Richard T. Silver, John Goldman, and Rudiger Hehlmann
From the Department of Hematology/Oncology, L. and A. Seràgnolì, University of Bologna; Division of Hematology, University Federico II, Naples; and Department of Clinical and Biological Sciences, University of Turin at Orbassano, Turin, Italy; Department of Haematology, Hammersmith Hospital; and Department of Haematology, Imperial College, London, United Kingdom; Hematology Department, Hospital Clinic, lnstitut d'lnvestigations Biomédiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Department of Hematology, University Hospital, Basel, Switzerland; CIC 802 INSERM, CHU de Poitiers, Poitiers, France; Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Institute of Medical and Veterinary Science, Adelaide, South Australia, Australia; Department of Medicine and Cancer Research Center, University of Chicago, Chicago, IL; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Hematology, University Hospital, Uppsala, Sweden; New York Presbyterian-Weill Cornell Medical Center, New York, NY; Department of Leukemia, M. D. Anderson Cancer Center, Houston, TX; Department of Medicine, Division of Hematology and Medical Oncology, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Department of Hematology and Oncology, University of Leipzig, Leipzig; Universitätsklinikum Jena, Jena; and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
* To whom correspondence should be addressed. E-mail: michele.baccarani{at}unibo.it
Purpose: To review and update the European LeukemiaNet (ELN) recommendations for the management of chronic myeloid leukemia with imatinib and second-generation tyrosine kinase inhibitors (TKIs), including monitoring, response definition, and first- and second-line therapy.
Methods: These recommendations are based on a critical and comprehensive review of the relevant papers up to February 2009 and the results of four consensus conferences held by the panel of experts appointed by ELN in 2008.
Results: Cytogenetic monitoring was required at 3, 6, 12, and 18 months. Molecular monitoring was required every 3 months. On the basis of the degree and the timing of hematologic, cytogenetic, and molecular results, the response to first-line imatinib was defined as optimal, suboptimal, or failure, and the response to second-generation TKIs was defined as suboptimal or failure.
Conclusion: Initial treatment was confirmed as imatinib 400 mg daily. Imatinib should be continued indefinitely in optimal responders. Suboptimal responders may continue on imatinb, at the same or higher dose, or may be eligible for investigational therapy with second-generation TKIs. In instances of imatinib failure, second-generation TKIs are recommended, followed by allogeneic hematopoietic stem-cell transplantation only in instances of failure and, sometimes, suboptimal response, depending on transplantation risk.
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