Current status and novel strategy of CML.

Area of Science:

• Hematology
• Oncology
• Pharmacology

Background:

• Tyrosine kinase inhibitors (TKIs) have transformed chronic myeloid leukemia (CML) treatment outcomes.
• Four TKIs are available for frontline therapy: imatinib (first-generation) and dasatinib, nilotinib, bosutinib (second-generation).

Purpose of the Study:

• To evaluate the role of second-generation TKIs in achieving deep molecular remission for potential CML treatment discontinuation.
• To discuss optimal TKI selection strategies for long-term therapy and functional cure in CML patients.

Main Methods:

• Review of current TKI treatment guidelines and clinical trial data for chronic-phase CML.
• Analysis of molecular response rates, survival benefits, and toxicity profiles of different TKIs.

Main Results:

• Second-generation TKIs induce faster and deeper molecular responses than imatinib, though without a significant survival advantage.
• Durable deep molecular remission is essential for treatment discontinuation and functional cure in CML.

Conclusions:

• Second-generation TKIs are recommended for initial therapy in chronic-phase CML to achieve necessary remission depth.
• Future strategies should focus on personalized TKI selection for long-term efficacy, reduced toxicity, and functional cure, potentially aided by AI-driven predictions.