European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013
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- Michele Baccarani
- Department of Hematology “L. and A. Seràgnoli,” S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy;
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- Michael W. Deininger
- Division of Hematology and Hematologic Malignancies, University of Utah Huntsman Cancer Institute, Salt Lake City, UT;
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- Gianantonio Rosti
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna and S.Orsola-Malpighi Hospital, Bologna, Italy;
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- Andreas Hochhaus
- Hematology/Oncology, Universitätsklinikum Jena, Jena, Germany;
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- Simona Soverini
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna and S.Orsola-Malpighi Hospital, Bologna, Italy;
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- Jane F. Apperley
- Centre for Hematology, Imperial College, London, United Kingdom;
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- Francisco Cervantes
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain;
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- Richard E. Clark
- Royal Liverpool University Hospital, Liverpool, United Kingdom;
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- Jorge E. Cortes
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX;
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- François Guilhot
- Institut National de la Santé et de la Recherche Médicale Centres d'investigation clinique 0802, CHU de Poitiers, Université de Poitiers, Poitiers, France;
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- Henrik Hjorth-Hansen
- Department of Hematology, St. Olavs Hospital, and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway;
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- Timothy P. Hughes
- SA Pathology and University of Adelaide, Adelaide, SA, Australia;
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- Hagop M. Kantarjian
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX;
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- Dong-Wook Kim
- Department of Hematology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea;
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- Richard A. Larson
- The University of Chicago, Chicago, IL;
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- Jeffrey H. Lipton
- Princess Margaret Hospital, University of Toronto, ON, Canada,
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- François-Xavier Mahon
- Laboratoire d’ Hématologie CHU de Bordeaux et Laboratoire Hématopoïese Leucémique et Cible Therapeutique, Université Bordeaux Ségalen, Institut National de la Santé et de la Recherche Médicale 1035, Bordeaux, France;
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- Giovanni Martinelli
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna and S.Orsola-Malpighi Hospital, Bologna, Italy;
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- Jiri Mayer
- University Hospital Brno and Central European Institute of Technology Masaryk University, Brno, Czech Republic;
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- Martin C. Müller
- III Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany;
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- Dietger Niederwieser
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany;
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- Fabrizio Pane
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, and CEINGE Biotecnologie Avanzate, Napoli, Italy;
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- Jerald P. Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA;
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- Philippe Rousselot
- Service d’ Hématologie et d’ Oncologie, Hôpital Mignot, Université Versailles Saint-Qentin-en-Yvelines, Versailles, France;
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- Giuseppe Saglio
- Department of Oncology, University of Turin, Turin, Italy;
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- Susanne Saußele
- III Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany;
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- Charles Schiffer
- Division of Medicine and Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI;
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- Richard Silver
- Weill Cornell Medical College, New York, NY;
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- Bengt Simonsson
- University Hospital, Uppsala, Sweden;
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- Juan-Luis Steegmann
- Servicio de Hematologia, Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain; and
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- John M. Goldman
- Department of Hematology, Imperial College, London, United Kingdom
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- Rüdiger Hehlmann
- III Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany;
説明
<jats:title>Abstract</jats:title><jats:p>Advances in chronic myeloid leukemia treatment, particularly regarding tyrosine kinase inhibitors, mandate regular updating of concepts and management. A European LeukemiaNet expert panel reviewed prior and new studies to update recommendations made in 2009. We recommend as initial treatment imatinib, nilotinib, or dasatinib. Response is assessed with standardized real quantitative polymerase chain reaction and/or cytogenetics at 3, 6, and 12 months. BCR-ABL1 transcript levels ≤10% at 3 months, <1% at 6 months, and ≤0.1% from 12 months onward define optimal response, whereas >10% at 6 months and >1% from 12 months onward define failure, mandating a change in treatment. Similarly, partial cytogenetic response (PCyR) at 3 months and complete cytogenetic response (CCyR) from 6 months onward define optimal response, whereas no CyR (Philadelphia chromosome–positive [Ph+] >95%) at 3 months, less than PCyR at 6 months, and less than CCyR from 12 months onward define failure. Between optimal and failure, there is an intermediate warning zone requiring more frequent monitoring. Similar definitions are provided for response to second-line therapy. Specific recommendations are made for patients in the accelerated and blastic phases, and for allogeneic stem cell transplantation. Optimal responders should continue therapy indefinitely, with careful surveillance, or they can be enrolled in controlled studies of treatment discontinuation once a deeper molecular response is achieved.</jats:p>
収録刊行物
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- Blood
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Blood 122 (6), 872-884, 2013-08-08
American Society of Hematology