Definitions of the response to second-line therapy in chronic myeloid leukemia after failure of imatinib

	Optimal	Warning	Failure
Baseline	NA	No CHR or loss of CHR on imatinib or lack of CyR to first-line TKI or high risk	NA
Three months	BCR-ABL1 ≤10 percent and/or Ph+ <65 percent	BCR-ABL1 >10 percent and/or Ph+ 65 to 95 percent	No CHR or Ph+ >95 percent or new mutations
Six months	BCR-ABL1 ≤10 percent and/or Ph+ <35 percent	Ph+ 35 to 65 percent	BCR-ABL1 >10 percent and/or Ph+ >65 percent and/or new mutations
12 months	BCR-ABL1 <1 percent and/or Ph+ 0	BCR-ABL1 1 to 10 percent and/or Ph+ 1 to 35 percent	BCR-ABL1 >10 percent and/or Ph+ >35 percent and/or new mutations
Then, and at any time	BCR-ABL1 ≤0.1 percent	CCA/Ph– (–7 or 7q–) or BCR-ABL1 >0.1 percent	Loss of CHR or loss of CCyR or PCyR New mutations Confirmed loss of MMR* CCA/Ph+

These definitions are mainly based on data reported for nilotinib and dasatinib, but can be used provisionally also for bosutinib and ponatinib, until more data are available. These definitions cannot apply to the evaluation of the response to third-line treatment.

NA: not applicable; CHR: complete hematologic response; CCyR: complete cytogenetic response; TKI: tyrosine kinase inhibitors; CCA/Ph–: clonal chromosome abnormalities in Ph– cells; PCyR: partial cytogenetic response; MMR: major molecular response, BCR-ABL1 ≥0.1 percent = MR^3.0 or better; CCA/Ph+: clonal chromosome abnormalities in Ph+ cells.
* In two consecutive tests, of which one with a BCR-ABL transcripts level ≥1 percent.

This research was originally published in Blood. Baccarani M, Deininger MW, Rosti G, et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013; 122:872-84. Copyright © the American Society of Hematology.

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Definitions of the response to second-line therapy in chronic myeloid leukemia after failure of imatinib