Has the time come for induction and maintenance imatinib therapy in chronic myeloid leukemia?

Imatinib has revolutionized the treatment of chronic myeloid leukemia (CML) and there is no doubt about its role in the first-line therapy of this myeloproliferation. However, there is continuing discussion about how to dose it. Routinely, avoiding single doses lower than 300 mg and continuous daily dosing has been recommended. Although the results of ongoing randomized trials with high-dose (600-800 mg daily) imatinib are far from being mature, we can see an accumulation of evidence that high-dose (or individually-adjusted high-dose) imatinib treatment for the induction of complete cytogenetic responses in patients in the chronic phase of CML after diagnosis might be more appropriate than routine standard dosing. On the other hand, at least some selected patients with a sufficiently long continual complete cytogenetic response may be switched to lower-dose (intermittent or pulsed) maintenance therapy. When supported by additional studies, this approach might represent an effective compromise that would save the patients from toxicity without losing the safety and efficacy of the treatment.