Molecular monitoring 101: helping your patients with chronic myeloid leukemia to understand the meaning of molecular response

Abstract

For patients with chronic myeloid leukemia (CML), measurement of molecular response (i.e. the level of BCR–ABL1 transcripts) is firmly established as a key element of disease monitoring. Assessment of BCR–ABL1 levels may help to identify early signs of resistance to treatment and enable a timely switch to alternative therapies. Hence, regular and accurate monitoring of BCR–ABL1 transcripts helps to maximize the chance of successful outcomes in CML. Because the incidence of CML is relatively low, many community oncologists encounter only a limited number of cases; measuring and interpreting BCR–ABL1 measurements in a clinically relevant fashion may be challenging. The team at our institution often encounters questions regarding real-time quantitative polymerase chain reaction assessments of BCR–ABL1 levels, International Scale standardization, the implications of achieving or losing molecular responses and mutation monitoring. The aim of this article is to provide practical advice for effective long-term monitoring of patients with CML by addressing frequently asked questions and common case scenarios using guideline- and evidence-based approaches.

Keywords::

• Chronic myeloid leukemia
• BCR–ABL1
• tyrosine kinase inhibitor therapy

Acknowledgements

Financial support for medical editorial assistance was provided by Novartis Pharmaceuticals. We thank Nathalie Acher, MD, Mariana Ovnic, PhD and Patricia Segarini, PhD of Percolation Communications LLC for their medical editorial assistance.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.