Guidelines for the treatment of chronic myeloid leukemia from the NCCN and ELN: differences and similarities

Özdemi̇r, Zehra; Kılıçaslan, Necati Alp; Yılmaz, Musa; Eşkazan, Ahmet Emre

doi:10.1007/s12185-022-03446-1

Cited by 24 publications

(16 citation statements)

References 109 publications

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“…The frequency of monitoring after discontinuation is similar to that mentioned in the 2020 ELN guidelines; however, patients who remain in the MMR would require quarterly monitoring after the TFR should be attempted only if the condition of the patient with CML is well controlled. Currently, qRT-PCR is used internationally as the gold standard for detecting BCR::ABL transcripts, 15 and its detection results are used as important indicators for evaluating the efficacy and prognosis of patients with CML. Digital droplet PCR (ddPCR), which has emerged recently, uses a water-oil emulsion droplet system that divides the sample into thousands of individually repeated PCRs.…”

Section: Current Guidelines For Tfrmentioning

confidence: 99%

Exploration of treatment‐free remission in CML, based on molecular monitoring

Zhang,

Zhou,

Zhou

et al. 2023

Cancer Medicine

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BackgroundTypical chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm caused by t(9; 22)(q34; q11) translocation. This chromosomal translocation forms the BCR::ABL1 fusion gene. The tyrosine kinase encoded by the BCR::ABL1 is considered to be the main pathogenic diver. BCR::ABL1 is not only a therapeutic target, but also a monitoring target. Monitoring of BCR::ABL1 reveals the progression of the disease and guides the next treatment. Now for CML, the target of treatment has been focused on treatment‐free remission (TFR).MethodsWe conducted a literature review of current developments of treatment‐free remission and molecular monitoring methods.ResultsMore effective and sensitive CML monitoring methods such as digital droplet PCR (ddPCR) and next generation sequencing (NGS) have further studied the measurable residual disease (MRD) and clonal heterogeneity, which provides strong support for the exploration of TFR. We discussed some of the factors that may be related to TFR outcomes at the molecular level, along with some monitoring strategies.ConclusionCurrently, predictive indicators for treatment‐free remission outcomes and recurrence are lacking in clinical practice. In future, treatment‐free remission research should focus on combining the clinical indicators with molecular monitoring and biological markers to personalize patient conditions and guide clinicians to develop individualized treatment plans, so that more patients with CML can achieve safer and stabler treatment‐free remission.

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Section: Current Guidelines For Tfrmentioning

confidence: 99%

Exploration of treatment‐free remission in CML, based on molecular monitoring

Zhang,

Zhou,

Zhou

et al. 2023

Cancer Medicine

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“…Landmark studies have indicated that discontinuing TKI is safe for patients with CML who have maintained a DMR for more than 2 years [4], ideally for more than 5 years [5]. International guidelines recommend quantitative reverse transcription-PCR (qRT-PCR) testing with a detection sensitivity lower than MR4.5 (0.0032% IS ) [2,3,6]. However, qRT-PCR has inherent limitations regarding its accuracy and sensitivity [7].…”

Section: Introductionmentioning

confidence: 99%

Analytical Performance Evaluation of a Digital Real‐Time PCR for Quantifying Major BCR::ABL1 Transcripts

Lee,

Ahn

et al. 2024

Clinical Laboratory Analysis

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BackgroundAccurate quantification of the BCR::ABL1 transcripts is essential for measurable residual disease (MRD) monitoring in chronic myeloid leukemia (CML) after tyrosine kinase inhibitor (TKI) treatment. This study evaluated the newly developed digital real‐time PCR method, Dr. PCR, as an alternative reverse transcription‐PCR (qRT‐PCR) for MRD detection.MethodsThe performance of Dr. PCR was assessed using reference and clinical materials. Precision, linearity, and correlation with qRT‐PCR were evaluated. MRD levels detected by Dr. PCR were compared with qRT‐PCR, and practical advantages were investigated.ResultsDr. PCR detected MRD up to 0.0032%IS (MR4.5) with excellent precision and linearity and showed a strong correlation with qRT‐PCR results. Notably, Dr. PCR identified higher levels of MRD in 12.7% (29/229) of patients than qRT‐PCR, including six cases of MR4, which is a critical level for TKI discontinuation. Dr. PCR also allowed for sufficient ABL1 copies in all cases, while qRT‐PCR necessitated multiple repeat tests in 3.5% (8/229) of cases.ConclusionOur study provides a body of evidence supporting the clinical application of Dr. PCR as a rapid and efficient method for assessing MRD in patients with CML under the current treatment regimen.

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“…Most patients tolerate this treatment well, and hematological toxicities ameliorate rapidly following discontinuation or tapering of imatinib. 1,2 Prolonged myelosuppression has rarely been reported and develops usually several months after imatinib administration. [3][4][5][6][7][8][9] A newly diagnosed CML-CP patient developed prolonged severe myelosuppression (lasting for more than 3 months) following only one week of imatinib at 400 mg/day as the solitary treatment.…”

Section: Introductionmentioning

confidence: 99%

Imatinib-induced severe hematological toxicity: Prolonged myelosuppression resulting from extraordinary sensitivity in an old age

Yang

et al. 2023

Eur J Inflamm

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The advent of tyrosine kinase inhibitors (TKIs) has profoundly changed the therapeutic landscape of chronic myeloid leukemia (CML) in the chronic phase (CML-CP). Imatinib is the first-generation, and the first and as yet the most widely used TKI, and the recommended dose is 400 mg/day for treating CML-CP. Most patients tolerate this treatment well, and prolonged hematological toxicities have rarely been reported. In this manuscript, we report a newly diagnosed CML-CP patient who developed prolonged myelosuppression (lasting for more than three months) following only one week of imatinib at 400 mg/day as the solitary treatment. Imatinib was discontinued, and pancytopenia persisted, with a continuous decrease in hemoglobulin levels. After restoration of autologous hematopoiesis, reintroduction of imatinib at 100 mg/day resulted in recurrent myelosuppression, and subsequent treatment with imatinib at 50 mg/day achieved good hematological homeostasis. We hypothesized that extraordinary sensitivity resulted in severe and prolonged myelosuppression.

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Guidelines for the treatment of chronic myeloid leukemia from the NCCN and ELN: differences and similarities

Cited by 24 publications

References 109 publications

Exploration of treatment‐free remission in CML, based on molecular monitoring

Exploration of treatment‐free remission in CML, based on molecular monitoring

Analytical Performance Evaluation of a Digital Real‐Time PCR for Quantifying Major BCR::ABL1 Transcripts

Imatinib-induced severe hematological toxicity: Prolonged myelosuppression resulting from extraordinary sensitivity in an old age

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