Management of CP CML

Consider the patient for a clinical trial – check the Clintrial NZ app or phone the clinical trials co-ordinator (ext: 80377). As of July 2018, a New Zealand based, Investigator lead study called KISS is recruiting newly diagnosed CML patients for treatment with up front dasatinib, switching to imatinib at 1 year if achieving a major molecular response (MMR).

TKIs are the mainstay of initial CML therapy following the pivotal IRIS study, which showed a marked overall survival benefit of imatinib over interferon plus cytrabine.

More potent second generation TKIs – nilotinib and dasatinib – have subsequently been found to induce more rapid attainment of MMR compared to imatinib, which in turn is associated with fewer progressions to accelerated or blast phase CML. However, all 3 drugs (nilotinib, dasatinib, and imatinib) have an overall survival rate after 5 years of 85%–95% and (as yet) no significant survival difference has been observed between imatinib and second generation inhibitors.

Subgroups of patients who possibly derive more benefit from initial use of a second generation TKI may include those with a high Sokal score at presentation, or those who may require a treatment-free interval in the foreseeable future (e.g. for pregnancy).

Cost is an important consideration in the choice of TKI. Generic imatinib (Imatinib-AFT) has been adopted by PHARMAC. In New Zealand, two TKIs are currently funded: imatinib and dasatinib.

As of July 2018, clinicians may ultimately choose the TKI they feel is most appropriate as up-front therapy in view of:

Usual recommended initial TKI dosing in CP CML


About this Canterbury DHB document (533087):
Document Owner:	Bridgett McDiarmid (see Who's Who)
Last Reviewed:	August 2018
Next Review:	April 2021
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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