How has treatment changed for blast phase chronic myeloid leukemia patients in the tyrosine kinase inhibitor era? A review of efficacy and safety

ABSTRACT

Introduction: Management of chronic myeloid leukemia (CML) patients in advanced phases of disease has drastically changed since the introduction of tyrosine kinase inhibitors (TKIs) which provide tailored treatment strategies.

Areas covered: In this review, efficacy data of different TKIs are reported and reviewed when used as single agent or in combination for the management of blast phase (BP) CML.

Expert opinion: Although brilliant results were achieved, the outcome of BP patients did not change when TKIs were used as single agents. Newer strategies of association of TKI with intensified chemotherapy or new agents for different pathways are strongly needed as a bridge to possible allogeneic transplant.

KEYWORDS:

• Chronic myeloid leukemia
• tyrosine kinase inhibitors
• blast phase
• outcome

Article highlights

• TKIs in chronic phase CML have drastically reduced evolution to blastic phase.

• TKIs allow achievement of transient haematological and cytogenetic responses in BP-CML as bridge to HSCT.

• TKIs combined with chemotherapy can achieve molecular remissions, but toxicity is higher.

• No randomized clinical trials compared results of these therapeutic strategies.

• Investigational agents not targeting ABL1 are strongly needed in BP CM

This box summarizes key points contained in this article.

Declaration of interest

M Breccia received honoraria from Novartis, Bristol, Pfizer and Ariad. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.