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How I Treat Chronic Myeloid Leukemia in Children and Adolescents

Nobuko Hijiya and Meinolf Suttorp

Abstract

Evidence-based recommendations have been established for treatment of chronic myeloid leukemia (CML) in adults treated with tyrosine kinase inhibitors (TKIs), but the rarity of this leukemia in children and adolescents makes it challenging to develop similar recommendations in pediatrics. In addition to imatinib, which was approved for pediatric CML in 2003, the second-generation TKIs dasatinib and nilotinib were recently approved for use in children, thus expanding the therapeutic options and pushing allogeneic stem cell transplantation to a third-line treatment for most pediatric cases. Yet without sufficient data on efficacy and safety specific to pediatric patients, the selection of a TKI continues to rely on clinical experience in adults. Here, we present 4 case scenarios highlighting common yet challenging issues encountered in the treatment of pediatric CML (suboptimal response, poor treatment adherence, growth retardation, and presentation in advanced phases). Limited experience with very young children, the transition of teenagers to adult medicine, and the goal of achieving treatment-free remission for this rare leukemia are additional significant obstacles that require further clinical investigation through international collaboration.

  • Submitted November 28, 2018.
  • Revision received March 19, 2019.
  • Accepted March 21, 2019.