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An Update on the Management of Advanced Phase Chronic Myeloid Leukemia

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Abstract

Purpose of Review

While most patients with chronic myeloid leukemia (CML) present in a chronic phase and are expected to have a normal life expectancy, some patients present with or progress to a more aggressive accelerated phase (AP) or blast phase (BP) of CML. Herein, we discuss the diagnostic considerations of advanced phase CML and review its contemporary management.

Recent Findings

Later-generation, more potent BCR::ABL1 tyrosine kinase inhibitors (TKIs) such as ponatinib may result in superior outcomes in patients with advanced phase CML. For CML-BP, combination approaches directed against the blast immunophenotype appear superior to TKI monotherapy. The role of allogeneic stem cell transplantation is controversial in CML-AP but has consistently been shown to improve outcomes for patients with CML-BP.

Summary

Advanced phase CML, particularly CML-BP, remains a poor risk subtype of CML. However, novel combination approaches using later-generation TKIs are being explored in clinical trials and may lead to improved outcomes.

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Abbreviations

CML:

Chronic myeloid leukemia

ELN:

European LeukemiaNet

WHO:

World Health Organization

BM:

Bone marrow

WBC:

White blood cells

ACA:

Additional cytogenetic abnormality

PB:

Peripheral blood

CNS:

Central nervous system

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Funding

Supported by an MD Anderson Cancer Center Support Grant (CA016672) and SPORE. N. J. S. is supported by the American Society of Hematology Junior Faculty Scholar Award in Clinical Research.

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Authors and Affiliations

  1. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Unit 428, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Nicholas J. Short, Jayastu Senapati & Elias Jabbour

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  1. Nicholas J. Short
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Correspondence to Nicholas J. Short.

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Conflict of Interest

N. J. S. has served as consultant for Pfizer Inc., GSK, NKARTA, and Sanofi, reports receiving research grants from Takeda Oncology, Astellas Pharma Inc., Xencor, Stemline Therapeutics, and NextCure, and has received honoraria from Novartis, Amgen, Pfizer Inc., Astellas Pharma Inc., Sanofi, and BeiGene. J. S. has been on the Advisory Board of Kite. E. J.: AbbVie: Consultancy, Research Funding; Cyclacel LTD: Research Funding; Pfizer: Consultancy, Research Funding; Takeda: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Adaptive: Consultancy, Research Funding; Amgen: Consultancy, Research Funding.

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Short, N.J., Senapati, J. & Jabbour, E. An Update on the Management of Advanced Phase Chronic Myeloid Leukemia. Curr Hematol Malig Rep 18, 234–242 (2023). https://doi.org/10.1007/s11899-023-00709-4

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