Canterbury DHB

Context

Response Definitions, Treatment Goals and Failures

The aim of therapy is to achieve at least a major molecular response (MMR) within 12 months of starting TKI. The deeper the response the better. Optimal response includes achieving MR4 by 18 months of TKI therapy.

As of July 2018, the ESMO CML guidelines (2017)6 are the most recent that outline:

Monitoring and response flow chart

CML monitoring and response flow chart

Indications for TKI mutation analysis

At diagnosis

AP or BP patients

During treatment

No CHR by 3 months

 

No MCR (Ph+ >35%) or PCR ≥10% by 6 months

 

No CCR (Ph+ >0%) or PCR ≥1% by 12 months

 

No MMR (PCR >0.1%) by 18 months

 

Loss of response

 

Significant increase in qPCR- 3.5 fold on a single occasion, or >2 fold on 2 occasions (monthly monitoring) and trending upwards

 

Appearance of clonal chromosomal abnormalities in Ph+ cells as detected by cytogenetics

 

Progression to AP or BP

About this Canterbury DHB document (533090):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

August 2018

Next Review:

April 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 533090