22. Therapy of Newly Diagnosed and Chronic-Phase Chronic Myeloid Leukemia

  1. Stefan Faderl MD Associate Professor and
  2. Hagop Kantarjian MD Chairman Professor
  1. Andreas Hochhaus MD Professor

Published Online: 4 JAN 2011

DOI: 10.1002/9781444327359.ch22

Leukemias: Principles and Practice of Therapy

Leukemias: Principles and Practice of Therapy

How to Cite

Hochhaus, A. (2010) Therapy of Newly Diagnosed and Chronic-Phase Chronic Myeloid Leukemia, in Leukemias: Principles and Practice of Therapy (eds S. Faderl and H. Kantarjian), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444327359.ch22

Editor Information

  1. Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston, TX, USA

Author Information

  1. Universitatsklinikum Jena, Klinik für Innere Medizin II, Abteilung Hamatolgie und Internistische Onkologie, Jena, Germany

Publication History

  1. Published Online: 4 JAN 2011
  2. Published Print: 26 NOV 2010

ISBN Information

Print ISBN: 9781405182355

Online ISBN: 9781444327359

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Keywords:

  • chronic myeloid leukemia (CML);
  • tyrosine kinase inhibitors;
  • Ph chromosome;
  • BCR-ABL;
  • imatinib;
  • allogeneic stem cell transplantation;
  • dasatinib;
  • nilotinib

Summary

Identification of BCR-ABL as the defining leukemogenic event in chronic myeloid leukemia (CML) revolutionized the understanding of the molecular pathogenesis of this disease. Imatinib has been designed as a potent selective BCR-ABL inhibitor, and is now considered the standard of care for the first-line therapy of patients with chronic phase CML based on its high long-term response rates and favorable tolerability profile compared with previous standard approaches. However, resistance to imatinib develops in 2–4% of patients annually. Attempts have been made to improve first-line therapy by increasing imatinib doses or combining imatinib with other drugs in selected cohorts, either in patients with a high risk or in the total population. As an alternative option, treatment escalation according to response at defined milestones has been proposed. Allogeneic stem cell transplantation remains an alternative for eligible patients after failure with imatinib or second-generation tyrosine kinase inhibitors. Despite improvement of transplant-related morbidity and mortality during the last decade, front-line transplantation is not recommended for most patients.