Recent Advances of Management for Chronic Myeloid Leukemia

The clinical outcome for patients with chronic myeloid leukemia (CML) has improved radically in the past 15 years. Imatinib led to high rates of complete cytogenetic responses and improved survival for patients with this disease. However, approximately 25-35 % of patients in chronic phase treated with imatinib developed treatment failure. Development of next-generation Tyrosine kinase inhibitors (TKIs), such as dasatinib, nilotinib, radotinib, bosutinib, and ponati-nib, has provided new therapeutic option for the patients resistant or intolerant to imatinib. Second generation (2G) TKIs were ac-tive in most clinically relevant BCR-ABL mutations, except highly resistant T315I. Through the phase 3 international randomized studies of 2G TKIs (dasatinib, nilotinib, and bosutinib) vs. imatinib, 2G TKIs emerged as the standard treatment for CML and have successfully prolonged the duration of both the chronic phase (CP) and the disease-free state. The majority of newly diagnosed patients treated with 2G TKIs achieved a complete cytogenetic response (CCyR), and over time, most of these eventually achieved major molecular responses (MMRs) and even complete molecular responses (CMRs). More recently, both dasatinib and nilotinib were approved for frontline use, and dasatinib, nilotinib, radotinib and bosutinib were approved for second-line use in patients with CML.