Naranie Shanmuganathan1,2,3,4,5, Timothy P Hughes6,7,8. 1. Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia. naranie.shanmuganathan@sa.gov.au. 2. School of Medicine, University of Adelaide, Adelaide, South Australia, Australia. naranie.shanmuganathan@sa.gov.au. 3. Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, South Australia, Australia. naranie.shanmuganathan@sa.gov.au. 4. Centre for Cancer Biology, SA Pathology, Frome Road, Adelaide, South Australia, Australia. naranie.shanmuganathan@sa.gov.au. 5. School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. naranie.shanmuganathan@sa.gov.au. 6. Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia. 7. School of Medicine, University of Adelaide, Adelaide, South Australia, Australia. 8. Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, South Australia, Australia.
Abstract
PURPOSE OF REVIEW: The marked improvement in clinical outcomes for patients with chronic myeloid leukaemia (CML) can be solely attributed to the introduction of targeted therapies against the fusion oncoprotein, BCR-ABL1. However, patient responses, although generally positive, remain heterogenous. Careful drug selection, ensuring the optimal TKI, is chosen for each patient and involves a complex decision process which incorporates consideration of numerous factors. RECENT FINDINGS: For some patients, with disease characteristics that indicate adverse intrinsic disease biology, more potent BCR-ABL1 inhibition is often appropriate, whereas other patients with major co-morbidities will benefit from a less aggressive approach to avoid life-shortening toxicities. For the vast majority of patients, the long-term goal of therapy will be the achievement of a deep molecular response and subsequent treatment-free remission and this consideration will play a large part in the drug selection process. We explore early management of CML, from the first presentation through to frontline therapy selection.
PURPOSE OF REVIEW: The marked improvement in clinical outcomes for patients with chronic myeloid leukaemia (CML) can be solely attributed to the introduction of targeted therapies against the fusion oncoprotein, BCR-ABL1. However, patient responses, although generally positive, remain heterogenous. Careful drug selection, ensuring the optimal TKI, is chosen for each patient and involves a complex decision process which incorporates consideration of numerous factors. RECENT FINDINGS: For some patients, with disease characteristics that indicate adverse intrinsic disease biology, more potent BCR-ABL1 inhibition is often appropriate, whereas other patients with major co-morbidities will benefit from a less aggressive approach to avoid life-shortening toxicities. For the vast majority of patients, the long-term goal of therapy will be the achievement of a deep molecular response and subsequent treatment-free remission and this consideration will play a large part in the drug selection process. We explore early management of CML, from the first presentation through to frontline therapy selection.
Entities:
Keywords:
Deep molecular responses; Drug toxicity; TKI; Treatment-free remission
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