Update on Issues in Treating and Monitoring Patients With CML
Posted: Thursday, May 9, 2019
A literature review, published in the Journal of Hematology & Oncology, discussed the latest advances and challenges in the clinical treatment and monitoring of patients with chronic myeloid leukemia (CML) and Philadelphia chromosome–positive (Ph+) acute lymphoblastic leukemia (ALL). Today, real-time quantitative polymerase chain reaction has become the “gold standard” for detecting BCR-ABL1 transcript levels for monitoring patient responses, anticipating relapse, and helping guide decision-making. Future directions are moving toward next-generation sequencing for greater sensitivity and the potential to discriminate between compound and polyclonal mutations, according to the authors.
“If the past decade has witnessed the [tyrosine kinase inhibitor] revolution, the next will welcome a fine-tuning of [tyrosine kinase inhibitor] use, with the definition of rational decision algorithms taking into account biologic and clinical prognostic/predictive factors, both at diagnosis and dynamically during the course of treatment,” Simona Soverini, PhD, of the University of Bologna, Italy, and colleagues concluded.
Using existing literature, the authors analyzed clinical outcomes of patients with CML and Ph+ ALL treated with tyrosine kinase inhibitors. Various tables, complete with reports from an assortment of randomized trials on treatment discontinuation, complete remission induction results, and more, are provided.
Clinical investigation of patients with CML is focusing on personalized patient monitoring as well as treatment-free remission rates. For those with Ph+ ALL, future directions are focused on optimizing treatment alternatives to maximize response rates as well as minimize side effects and treatment-related mortality. Although there have been many advances in technology that have significantly improved the assessment and treatment of patients with CML and Ph+ ALL, challenges remain, such as identifying which patients would benefit from an early switch in treatment and how best to select candidates for treatment discontinuation.
Disclosure: The study authors’ disclosure information may be found at jhoonline.biomedcentral.com.