Treatment strategies for CML

Little important progress was made in terms of prolongation of life for patients with chronic myeloid leukaemia (CML) until the advent of interferon-alpha and allogeneic stem cell transplantation in the 1980s. However, in 1998 the introduction of imatinib, the first tyrosine kinase inhibitor (TKI) that specifically targets the BCR-ABL1 oncoprotein, has fundamentally altered treatment strategies for patients in all phases of CML. Imatinib is now recommended as initial treatment for all patients who present in chronic phase (CP) and about two-thirds of patients so treated will be in continuing complete cytogenetic response 7 or more years after starting therapy. A small proportion of these patients can stop the drug without molecular evidence of relapse. For the minority of patients who are judged to have failed initial treatment with imatinib at standard dosage or increased dosage, the use of second-generation TKI or allogeneic stem cell transplantation must be considered.