The frontline treatment of chronic myeloid leukemia in the chronic phase: current clinical decisions and future prospects for treatment

Abstract

The use of tyrosine kinase inhibitors (TKIs) has revolutionized the treatment of chronic myeloid leukemia (CML). For patient with chronic phase CML, frontline treatment with imatinib leads to an estimated event-free survival and overall survival at 8 years of 81 and 85%, respectively. Second-generation TKIs (dasatinib and nilotinib) have shown improved early cytogenetic and molecular end points compared with imatinib in frontline randomized studies. Imatinib, dasatinib and nilotinib are all now approved for the frontline therapy. Overall treatment success is dependent in large part on treatment compliance, effective management of side effects of the therapy and close monitoring and achievement of cytogenetic and molecular milestones.

Keywords::

• chronic myelogenous leukemia
• dasatinib
• imatinib
• treatment
• tyrosine kinase inhibitors

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Tyrosine kinase inhibitors (TKIs) have dramatically changed the outcome of patients with chronic myeloid leukemia (CML).

• • Imatinib, dasatinib and nilotinib are approved for frontline therapy for patients with chronic phase (CP) CML.

• • Dasatinib and nilotinib have been shown to lead to faster and deeper responses compared with imatinib in randomized clinical trials.

• • The best frontline treatment strategy for patients with CML remains unclear at this time.

• • Treatment compliance is very important for treatment success.

• • Treatment monitoring end points should be closely followed for each patient.