Chronic Myeloid Leukemia: Selecting First-line TKI Therapy

In the event of neutropenia or thrombocytopenia, ponatinib should be held until blood count recovery and then restarted at the same dose. If cytopenias occur for a second time, the dose of ponatinib should be lowered at the time of treatment reinitiation. If rash occurs, it can be addressed with topical or systemic steroids as well as dose reduction, interruption, or discontinuation.¹⁹

Conclusion

With the development of imatinib and the subsequent TKIs, dasatinib, nilotinib, bosutinib, and ponatinib, CP-CML has become a chronic disease with a life expectancy that is similar to that of the general population. Given the successful treatments available for these patients, it is crucial to identify patients with this diagnosis, ensure they receive a complete, appropriate diagnostic workup including a bone marrow biopsy and aspiration with cytogenetic testing, and select the best therapy for each individual patient. Once on treatment, the importance of frequent monitoring cannot be overstated. This is the only way to be certain patients are achieving the desired treatment milestones that correlate with the favorable long-term outcomes that have been observed with TKI-based treatment of CP-CML. 

Corresponding author: Kendra Sweet, MD, MS, Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL.

Financial disclosures: Dr. Sweet has served on the Advisory Board and Speakers Bureau of Novartis, Bristol-Meyers Squibb, Ariad Pharmaceuticals, and Pfizer, and has served as a consultant to Pfizer.