Improving Outcomes in Chronic Myeloid Leukemia Over Time in the Era of Tyrosine Kinase Inhibitors

Publication date: Available online 4 July 2018Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Pradnya Chopade, Luke P. AkardAbstractMost patients with chronic myeloid leukemia (CML) receiving treatment with BCR-ABL1 tyrosine kinase inhibitors (TKIs) achieve favorable responses; moreover, TKI therapy enables patients to achieve long-term survival, with survival rates similar to those of individuals without CML. This enhanced survival has resulted from the availability of multiple BCR-ABL1 TKIs with efficacy not only in frontline treatment, but importantly, also in second- and third-line treatment. Here, we review the changes in long-term outcomes in the era of TKI therapy and how these changes have impacted treatment practices. We discuss the development of imatinib, the first BCR-ABL1 TKI, followed by newer TKIs, including nilotinib, dasatinib, bosutinib, and ponatinib. We consider the key studies that led to their development as frontline or later-line therapies, their safety profiles, and their impact on improving patient outcomes. Due to these improved outcomes, the definition of an optimal response has become more stringent, and treatment monitoring strategies have changed. Second-line patient populations have evolved from those with resistance to or intolerance of imatinib, to those with moderate responses to or low-grade adverse events with imatinib. Although all TKIs are associated with high survival rates, newer TKIs are associated with lower disease progress...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research