Molecular monitoring of patients with chronic myeloid leukemia: clinical examples from a non-trial setting

The molecular monitoring of chronic myeloid leukemia allows the clinician a minimally invasive method to judge response to tyrosine kinase therapy and to predict outcome and relapse. Because there are several treatment options for patients with suboptimal response, the ability to proactively predict and respond to relapse makes the "personalization" of treatment a realizable goal. There are practical issues with molecular monitoring, however, including availability of assays, standardization of tests, and the learning curve as doctors and patients learn to follow BCR-ABL levels with interest and reason. This review will examine the use of molecular monitoring in the non-trial setting, concentrating on pitfalls that can occur in the real-world delivery of complex medical care.