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The Choice of First-Line Chronic Myelogenous Leukemia Treatment

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Book cover Chronic Myeloid Leukemia

Part of the book series: Hematologic Malignancies ((HEMATOLOGIC))

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Abstract

Imatinib has represented a revolution in the treatment of chronic myeloid leukemia (CML), inducing an overall survival never seen with previous therapies. However, with the commonly used dosage of 400 mg, one third of the treated patients do not reach the criteria associated with an optimal outcome and could potentially benefit from a different treatment strategy. Several trials exploring modified imatinib-based treatments or second-generation tyrosine kinase as frontline therapy have been performed. In some studies, high-dose (800 mg per day) or dose-adapted imatinib or imatinib plus interferon was reported to be able to induce better cytogenetic and molecular responses compared with standard-dose imatinib, although no improvements in progression-free survival (PFS) or overall survival (OS) have been so far reported. At the moment, these approaches are still considered investigational. On the other side, on the basis of their capacity to induce very fast and deep molecular responses, including major molecular responses (MMRs) and the newly defined very deep molecular responses MR4 and MR4.5, and to prevent at least part of the early progressions to AP/BC that still occur during the first 2–3 years from diagnosis, dasatinib and nilotinib have been approved and registered by FDA and EMA as the first-line therapy for CML patients, opening the possibility to use different therapeutic strategies for newly diagnosed CML patients and a consequent intense debate among hematologists.

Parts of this chapter have formerly been published within the journal Annals of Hematology in Volume 94, Issue 2, supplement, April 2015, “Chronic Myeloid Leukemia,” doi:10.1007/s00277-015-2321-3.

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Authors and Affiliations

  1. Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

    Carmen Fava, Giovanna Rege-Cambrin, Irene Dogliotti & Giuseppe Saglio

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  1. Carmen Fava
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  2. Giovanna Rege-Cambrin
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  3. Irene Dogliotti
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  4. Giuseppe Saglio
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Correspondence to Giuseppe Saglio .

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  1. Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany

    Rüdiger Hehlmann

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Fava, C., Rege-Cambrin, G., Dogliotti, I., Saglio, G. (2016). The Choice of First-Line Chronic Myelogenous Leukemia Treatment. In: Hehlmann, R. (eds) Chronic Myeloid Leukemia. Hematologic Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-319-33198-0_3

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  • DOI: https://doi.org/10.1007/978-3-319-33198-0_3

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