Tyrosine Kinase Inhibitors for Chronic Myeloid Leukemia—Is There an Optimal Treatment Plan?

Abstract

Chronic myeloid leukemia (CML) is the first hematological malignancy in which understanding of the disease pathogenesis has led to rational design therapy. Imatinib mesylate, a first-generation tyrosine kinase inhibitor (TKI), is the current standard of care for patients with chronic-phase CML (CML-CP). It is the only targeted therapy in CML with proven long-term efficacy and safety. Two potent second-generation TKIs, nilotinib and dasatinib, are currently approved for patients who are resistant to or intolerant of imatinib or who are diagnosed with advanced disease. Alternatives for front-line TKI therapy are under active investigation and emerging data indicate that first-line therapy with high-dose imatinib, dasatinib, or nilotinib may be of benefit. Selection of a second-line therapy should consider the side-effect profile, patient comorbidities, type and stage of disease, mutational status, and other practical considerations.