Optimal initial therapy for patients with newly diagnosed chronic myeloid leukemia in chronic phase

Imatinib mesylate, a tyrosine kinase inhibitor, has revolutionized the therapy of newly diagnosed patients with chronic myeloid leukemia. Prior to imatinib, treatment algorithms for chronic myeloid leukemia patients recommended stem cell transplantation for patients less than 50 years old who had a donor and could undergo stem cell transplantation. Other than stem cell transplantation, interferon was the only drug that could induce cytogenetic remissions in minority of patients.

After 5 years of follow-up, the rate of relapse with imatinib therapy continues to decrease, and the numbers of patients achieving a complete molecular response continue to increase. In addition, with a longer follow up, imatinib continues to be safe and easily tolerated. Recent studies have shown a survival benefit with imatinib. The use of imatinib before stem cell transplant did not have an effect on mortality or morbidity posttransplant.

Currently, imatinib is considered first line therapy in all patients with early chronic phase chronic myeloid leukemia with stem cell transplant reserved for patients who have disease resistant to imatinib therapy. Our aim is to review current recommendations for initial therapy of patients with early chronic phasechronic myeloid leukemia, current areas of controversy and future directions.