Early Management of CML

Curr Hematol Malig Rep. 2019 Dec;14(6):480-491. doi: 10.1007/s11899-019-00550-8.


Purpose of review: The marked improvement in clinical outcomes for patients with chronic myeloid leukaemia (CML) can be solely attributed to the introduction of targeted therapies against the fusion oncoprotein, BCR-ABL1. However, patient responses, although generally positive, remain heterogenous. Careful drug selection, ensuring the optimal TKI, is chosen for each patient and involves a complex decision process which incorporates consideration of numerous factors.

Recent findings: For some patients, with disease characteristics that indicate adverse intrinsic disease biology, more potent BCR-ABL1 inhibition is often appropriate, whereas other patients with major co-morbidities will benefit from a less aggressive approach to avoid life-shortening toxicities. For the vast majority of patients, the long-term goal of therapy will be the achievement of a deep molecular response and subsequent treatment-free remission and this consideration will play a large part in the drug selection process. We explore early management of CML, from the first presentation through to frontline therapy selection.

Keywords: Deep molecular responses; Drug toxicity; TKI; Treatment-free remission.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Clinical Decision-Making
  • Comorbidity
  • Disease Management
  • Early Detection of Cancer
  • Family Planning Services
  • Fertility Preservation
  • Genetic Testing
  • Humans
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / diagnosis*
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / etiology
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / therapy*
  • Medication Adherence
  • Retreatment
  • Time Factors
  • Time-to-Treatment
  • Treatment Outcome


  • Antineoplastic Agents