Table 8

Treatment strategy recommendations for CML in AP or BP

AP and BP in newly diagnosed, TKI-naïve patientsImatinib 400 mg twice daily
or
dasatinib 70 mg twice daily
or
140 mg once daily
Stem cell donor search.
Then, alloSCT is recommended for all BP patients and for the AP patients who do not achieve an optimal response.
Chemotherapy may be required before alloSCT, to control the disease.
AP and BP as a progression from CP in TKI-pretreated patientsAnyone of the TKIs that were not used before progression (ponatinib in case of T315I mutation), then alloSCT in all patients.
Chemotherapy is frequently required to make patients eligible for alloSCT.
  • In treatment-naïve patients, AP is believed to be close to high-risk CP, so that TKIs have priority. In patients who progress to AP or BP during TKI therapy, the response to any subsequent treatment is poorer, and less durable, so that alloSCT is recommended for all patients who are eligible for the procedure. However, in these patients, not only TKIs but also cytotoxic chemotherapy may be necessary to reinsert some degree of remission to permit alloSCT. In case of uncontrolled, resistant BP, alloSCT is not recommended. All recommendations for alloSCT imply that the patient is eligible for that procedure. Note that nilotinib was tested, but not approved, for the treatment of BP.119,121,122