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The Evolving Landscape of Frontline Therapy in Chronic Phase Chronic Myeloid Leukemia (CML)

  • Chronic Myeloid Leukemias (MJ Mauro and G Saglio, Section Editors)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by uncontrolled proliferation of mature and maturing granulocytes. The disease is characterized by the presence of translocation t(9;22) leading to the abnormal BCR-ABL fusion. Historically, treatment options included hydroxyurea, busulfan, and interferon-α (IFN-α), with allogeneic stem cell transplant being the only potential curative therapy. More recently, the development of tyrosine kinase inhibitors (TKIs) has revolutionized the treatment of CML and turned a once fatal disease into a chronic and manageable disorder. This review aims to discuss the frontline treatment options in chronic-phase CML, provide recommendations for tailoring frontline treatment to the patient, and explore emerging therapies in the field.

Recent Findings

The first-generation TKI, imatinib, was FDA approved in 2001 for use in CML. Following the approval and success of imatinib, second- and third-generation TKIs have been developed providing deeper responses, faster responses, and different toxicity profiles. With numerous options available in the frontline setting, choosing the best initial treatment for each individual patient has become a more complex decision.

Summary

When choosing a frontline therapy for patients with chronic-phase CML, one should consider disease risk, comorbid conditions, and the goal of therapy.

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Funding

H.W. is supported by an institutional NIH T32 training grant.

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Authors and Affiliations

  1. Division of Malignant Hematology and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, 27707, USA

    Heather R. Wolfe & Lindsay A. M. Rein

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  1. Heather R. Wolfe
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  2. Lindsay A. M. Rein
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Corresponding author

Correspondence to Heather R. Wolfe.

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Conflict of Interest

Dr. Heather R. Wolfe has no conflict of interest to disclose; Dr. Lindsey Rein has received advisor/consultant fees from Novartis, Celgene Blueprints Medicine, and Clinical Care Options. Dr. Rein is the site principal investigator (PI) for clinical trials sponsored by the following companies/entities: SWOG, CTI BioPharma, Blueprints Medicine, Actuate Therapeutics, Celgene, Imago BioSciences, Incyte Corporation, Kiadis, and Sumitomo Dainippon Pharma Oncology.

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This article is part of Topical Collection on Chronic Myeloid Leukemias

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Wolfe, H.R., Rein, L.A.M. The Evolving Landscape of Frontline Therapy in Chronic Phase Chronic Myeloid Leukemia (CML). Curr Hematol Malig Rep 16, 448–454 (2021). https://doi.org/10.1007/s11899-021-00655-z

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