Treatment Sequencing in Patients With Ph+ Chronic-Phase CML

Neil P. Shah, MD, PhD


March 30, 2021

Chronic myeloid leukemia (CML) can be Philadelphia chromosome positive (Ph+) and contain a fusion gene and protein called BCR-ABL1. The vast majority of CML patients are diagnosed in the chronic phase, which is generally well controlled. Ph+ CML is treated initially with a BCR-ABL1 tyrosine kinase inhibitor (TKI) such as imatinib, dasatinib, nilotinib, or bosutinib.

Today, most patients with Ph+ chronic-phase CML treated with TKI therapy are expected to have a near-normal life expectancy. Nevertheless, some patients develop resistance to frontline TKI therapy or experience adverse effects that undermine treatment adherence.

Dr Neil Shah, professor in the Division of Hematology/Oncology at University of California, San Francisco, discusses the most effective approach to treatment sequencing in patients with Ph+ chronic-phase CML, including what prompts a switch to second-line therapy and what can be done to maximize the probability of an adequate, sustained response to treatment. Dr Shah also discusses some emerging agents.


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