@article{9056b71b2671401183c5d301e24b50ef,
title = "European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia",
abstract = "The therapeutic landscape of chronic myeloid leukemia (CML) has profoundly changed over the past 7 years. Most patients with chronic phase (CP) now have a normal life expectancy. Another goal is achieving a stable deep molecular response (DMR) and discontinuing medication for treatment-free remission (TFR). The European LeukemiaNet convened an expert panel to critically evaluate and update the evidence to achieve these goals since its previous recommendations. First-line treatment is a tyrosine kinase inhibitor (TKI; imatinib brand or generic, dasatinib, nilotinib, and bosutinib are available first-line). Generic imatinib is the cost-effective initial treatment in CP. Various contraindications and side-effects of all TKIs should be considered. Patient risk status at diagnosis should be assessed with the new EUTOS long-term survival (ELTS)-score. Monitoring of response should be done by quantitative polymerase chain reaction whenever possible. A change of treatment is recommended when intolerance cannot be ameliorated or when molecular milestones are not reached. Greater than 10% BCR-ABL1 at 3 months indicates treatment failure when confirmed. Allogeneic transplantation continues to be a therapeutic option particularly for advanced phase CML. TKI treatment should be withheld during pregnancy. Treatment discontinuation may be considered in patients with durable DMR with the goal of achieving TFR.",
author = "A. Hochhaus and M. Baccarani and Silver, {R. T.} and C. Schiffer and Apperley, {J. F.} and F. Cervantes and Clark, {R. E.} and Cortes, {J. E.} and Deininger, {M. W.} and F. Guilhot and H. Hjorth-Hansen and Hughes, {T. P.} and Janssen, {J. J.W.M.} and Kantarjian, {H. M.} and Kim, {D. W.} and Larson, {R. A.} and Lipton, {J. H.} and Mahon, {F. X.} and J. Mayer and F. Nicolini and D. Niederwieser and F. Pane and Radich, {J. P.} and D. Rea and J. Richter and G. Rosti and P. Rousselot and G. Saglio and S. Sau{\ss}ele and S. Soverini and Steegmann, {J. L.} and A. Turkina and A. Zaritskey and R. Hehlmann",
note = "Funding Information: The ELN panel for recommendations in CML comprises 34 experts from Europe, America, and the Asian-Pacific areas. The panel met six times at international meetings of the American Society of Hematology (2015, 2016), the European School of Hematology (2017), the ELN (2019), the European Investigators on CML (2019), and the European School of Hematology/International CML Foundation (2019). Five sets of key questions were submitted to panel members to complement the meetings. Discordant opinions were harmonized by email discussions, and a consensus of 75–100% was reached in most, but not all instances. Unresolved controversies are described in the discussion section. The costs of the meetings and the preparation of the interim and final reports were born entirely by ELN, a research network of excellence initiated by the European Union, now funded by donations and projects of ELN participants. There was no financial support from industry for any activity. Treatment recommendations are limited to the TKIs that have been approved with at least one indication in CML, either by the US Federal Drug Administration (FDA) or/and by the European Medicine Agency (EMA). The drugs are listed in the order of FDA approval. The panel acknowledges that not all drugs may be available worldwide and that the high price of some makes access to these drugs problematic in some countries. Publisher Copyright: {\textcopyright} 2020, The Author(s).",
year = "2020",
month = apr,
doi = "10.1038/s41375-020-0776-2",
language = "English (US)",
volume = "34",
pages = "966--984",
journal = "Leukemia",
issn = "0887-6924",
publisher = "Nature Publishing Group",
number = "4",
}