Version June 2024
For RT-PCR values close to the thresholds in the algorithm, the study should be repeated within 1 to 2 months; importantly, the trend is more important than a single value for making treatment decisions. Changes of TKI should be avoided in response to early mild adverse effects, such as rash, nausea, or depression; a temporary TKI dose reduction or brief interruption may help evaluate the relation of such symptoms to the TKI. Significant or symptomatic cytopenias may be managed with transfusions for anemia, myeloid growth factors for neutropenia, and platelet transfusions or a TPO-R agonist for thrombocytopenia.
This algorithm should be used in conjunction with related UpToDate topics, which also discuss classification of CML, selection of an initial TKI, management of adverse effects, importance of treatment adherence, possible drug interactions, additional details of treatment monitoring and responses, and considerations for TKI discontinuation.TKI: tyrosine kinase inhibitor; CBC: complete blood count and differential count; WBC: white blood cells; RT-PCR: reverse transcriptase polymerase chain reaction; TPO-R: thrombopoietin receptor agonist; FISH: fluorescence in situ hybridization.
* We generally obtain a CBC weekly for the first month of treatment, every two weeks in the second month, and as needed in the third month.
¶ In addition to RT-PCR, assessment of cytogenetic response by karyotype or FISH is encouraged, but not required, in the first year of treatment or until a complete cytogenetic response is achieved. Rising levels of BCR::ABL1 at successive quarterly testing in the first year should be considered a "warning" and testing should be repeated in 1 to 2 months.
Δ Experts differ regarding the target molecular response (eg, <0.1% versus <1%).
◊ Selected patients may be considered for a trial of treatment-free remission; refer to related UpToDate topics for criteria and management.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
