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[Chronic myeloid leukemia: 2024 update on novel therapeutic strategies]
Yosuke Minami1, Ryo Yoshimaru1
1Department of Hematology, National Cancer Center Hospital East.
Abstract:
Many patients with chronic myeloid leukemia (CML) can now maintain response thanks to the advent of tyrosine kinase inhibitors (TKIs) and STAMP inhibitors, but adverse events associated with prolonged TKI therapy have become a problem. Adequate management of adverse events is key to successful treatment, as some can significantly impact the patient's prognosis. The goal of CML treatment was once to prevent acute transformation, but now that many patients achieve deep remission and long-term survival, the goal has shifted to achieving long-term treatment free remission (TFR). It is essential to carefully consider disease risk, patient background, and adverse events of each therapeutic agent in order to make the appropriate choice. This article reviews the treatment of chronic phase CML (CML-CP) as described in the 2023 edition of the Guidelines for Hematopoietic Tumors, focusing on treatment options for first-line CML-CP, dose optimization of ponatinib, outcomes with the new CML drug asciminib, and TFR.
Insights
Managing adverse events is crucial for chronic myeloid leukemia (CML) patients on tyrosine kinase inhibitors (TKIs). The focus is shifting towards achieving treatment-free remission (TFR) while optimizing therapy.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Context:
- Chronic myeloid leukemia (CML) management has evolved with tyrosine kinase inhibitors (TKIs).
- Prolonged TKI therapy presents challenges with adverse events impacting patient prognosis.
- The treatment goal has shifted from preventing transformation to achieving long-term treatment-free remission (TFR).
Purpose:
- To review the 2023 Guidelines for Hematopoietic Tumors regarding chronic phase CML (CML-CP) treatment.
- To discuss first-line treatment options, dose optimization of ponatinib, and outcomes with asciminib.
- To explore strategies for achieving treatment-free remission (TFR) in CML patients.
Summary:
- Advances in TKIs and STAMP inhibitors improve response rates in CML patients.
- Effective management of adverse events is critical for successful long-term treatment and prognosis.
- The 2023 guidelines emphasize personalized treatment choices considering disease risk, patient factors, and drug toxicities.
Impact:
- Optimized CML treatment strategies can improve patient survival and quality of life.
- The shift towards TFR offers potential for reduced long-term treatment burden and toxicity.
- Informed therapeutic decisions based on updated guidelines and novel agents like asciminib can enhance CML management.
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