European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013

Michele Baccarani, Michael W. Deininger, Gianantonio Rosti, Andreas Hochhaus, Simona Soverini, Jane F. Apperley, Francisco Cervantes, Richard E. Clark, Jorge E. Cortes, François Guilhot, Henrik Hjorth-Hansen, Timothy P. Hughes, Hagop M. Kantarjian, Dong Wook Kim, Richard A. Larson, Jeffrey H. Lipton, François Xavier Mahon, Giovanni Martinelli, Jiri Mayer, Martin C. MüllerDietger Niederwieser, Fabrizio Pane, Jerald P. Radich, Philippe Rousselot, Giuseppe Saglio, Susanne Saußele, Charles Schiffer, Richard Silver, Bengt Simonsson, Juan Luis Steegmann, John M. Goldman, Rüdiger Hehlmann

Research output: Contribution to journalReview article

Abstract

Advances in chronic myeloid leukemia treatment, particularly regarding tyro-sine 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, nilo-tinib, or dasatinib. Response is assessed with standardized real quantitative poly-merase 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.

Original languageEnglish (US)
Pages (from-to)872-884
Number of pages13
JournalBlood
Volume122
Issue number6
DOIs
StatePublished - Aug 8 2013

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Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Chromosomes
Stem cells
Cytogenetics
Phosphotransferases
Monitoring
Therapeutics
Philadelphia Chromosome
Stem Cell Transplantation
Dasatinib
Imatinib Mesylate

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Baccarani, M., Deininger, M. W., Rosti, G., Hochhaus, A., Soverini, S., Apperley, J. F., ... Hehlmann, R. (2013). European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood, 122(6), 872-884. https://doi.org/10.1182/blood-2013-05-501569

European LeukemiaNet recommendations for the management of chronic myeloid leukemia : 2013. / Baccarani, Michele; Deininger, Michael W.; Rosti, Gianantonio; Hochhaus, Andreas; Soverini, Simona; Apperley, Jane F.; Cervantes, Francisco; Clark, Richard E.; Cortes, Jorge E.; Guilhot, François; Hjorth-Hansen, Henrik; Hughes, Timothy P.; Kantarjian, Hagop M.; Kim, Dong Wook; Larson, Richard A.; Lipton, Jeffrey H.; Mahon, François Xavier; Martinelli, Giovanni; Mayer, Jiri; Müller, Martin C.; Niederwieser, Dietger; Pane, Fabrizio; Radich, Jerald P.; Rousselot, Philippe; Saglio, Giuseppe; Saußele, Susanne; Schiffer, Charles; Silver, Richard; Simonsson, Bengt; Steegmann, Juan Luis; Goldman, John M.; Hehlmann, Rüdiger.

In: Blood, Vol. 122, No. 6, 08.08.2013, p. 872-884.

Research output: Contribution to journalReview article

Baccarani, M, Deininger, MW, Rosti, G, Hochhaus, A, Soverini, S, Apperley, JF, Cervantes, F, Clark, RE, Cortes, JE, Guilhot, F, Hjorth-Hansen, H, Hughes, TP, Kantarjian, HM, Kim, DW, Larson, RA, Lipton, JH, Mahon, FX, Martinelli, G, Mayer, J, Müller, MC, Niederwieser, D, Pane, F, Radich, JP, Rousselot, P, Saglio, G, Saußele, S, Schiffer, C, Silver, R, Simonsson, B, Steegmann, JL, Goldman, JM & Hehlmann, R 2013, 'European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013', Blood, vol. 122, no. 6, pp. 872-884. https://doi.org/10.1182/blood-2013-05-501569
Baccarani M, Deininger MW, Rosti G, Hochhaus A, Soverini S, Apperley JF et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013 Aug 8;122(6):872-884. https://doi.org/10.1182/blood-2013-05-501569
Baccarani, Michele ; Deininger, Michael W. ; Rosti, Gianantonio ; Hochhaus, Andreas ; Soverini, Simona ; Apperley, Jane F. ; Cervantes, Francisco ; Clark, Richard E. ; Cortes, Jorge E. ; Guilhot, François ; Hjorth-Hansen, Henrik ; Hughes, Timothy P. ; Kantarjian, Hagop M. ; Kim, Dong Wook ; Larson, Richard A. ; Lipton, Jeffrey H. ; Mahon, François Xavier ; Martinelli, Giovanni ; Mayer, Jiri ; Müller, Martin C. ; Niederwieser, Dietger ; Pane, Fabrizio ; Radich, Jerald P. ; Rousselot, Philippe ; Saglio, Giuseppe ; Saußele, Susanne ; Schiffer, Charles ; Silver, Richard ; Simonsson, Bengt ; Steegmann, Juan Luis ; Goldman, John M. ; Hehlmann, Rüdiger. / European LeukemiaNet recommendations for the management of chronic myeloid leukemia : 2013. In: Blood. 2013 ; Vol. 122, No. 6. pp. 872-884.
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abstract = "Advances in chronic myeloid leukemia treatment, particularly regarding tyro-sine 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, nilo-tinib, or dasatinib. Response is assessed with standardized real quantitative poly-merase 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.",
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AU - Apperley, Jane F.

AU - Cervantes, Francisco

AU - Clark, Richard E.

AU - Cortes, Jorge E.

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AU - Mahon, François Xavier

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AU - Mayer, Jiri

AU - Müller, Martin C.

AU - Niederwieser, Dietger

AU - Pane, Fabrizio

AU - Radich, Jerald P.

AU - Rousselot, Philippe

AU - Saglio, Giuseppe

AU - Saußele, Susanne

AU - Schiffer, Charles

AU - Silver, Richard

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AU - Steegmann, Juan Luis

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