Management of advanced-phase chronic myeloid leukemia

The introduction of tyrosine kinase inhibitors (TKIs) has dramatically changed the management of patients with chronic myeloid leukemia (CML). Despite improved outcomes for most CML patients, disease progression from chronic phase (CP) to accelerated phase (AP) or blast phase (BP) occurs in 1-1.5% of cases per year with current TKI therapy. In addition, about 10-15% of newly diagnosed patients present in AP or BP. Even in the TKI era, the prognosis of patients with advanced-phase CML is not satisfactory. Although de novo AP patients who respond optimally to TKI have excellent outcomes, the prognosis of the remaining advanced-phase CML patients treated with TKI remains poor. For advanced-phase CML patients, allogeneic stem cell transplantation (allo-HSCT) is the only curative therapy. Patients eligible for allo-HSCT should first be treated with TKI with or without chemotherapy, in order to obtain reversion to CP, followed promptly by allo-HSCT. At present, the survival rates of patients undergoing allo-HSCT for advanced-phase CML are still disappointing. Prophylactic or preemptive administration of TKIs after allo-HSCT may improve long-term survival. Further investigation to improve the treatment outcomes of patients with advanced-phase CML is warranted.