Submitted April 19, 2007
Accepted June 12, 2007
How I treat chronic myeloid leukemia in the imatinib era
John M. Goldman*
Department of Haematology, Imperial College at Hammersmith Hospital, London, United Kingdom
* Corresponding author; email: jgoldman{at}imperial.ac.uk.
Though it is now generally accepted that imatinib is the best initial treatment for patients newly diagnosed with CML in chronic phase, a number of questions remain unanswered. For example, (1) Is imatinib the best initial treatment for every patient? (2) At what dose should imatinib be started? (3) How should response to treatment be monitored? (4) For how long should the drug be continued in patients who have achieved and maintained a complete molecular response? (5) How does one handle a patient who achieves a 2-log but not a 3-log reduction in BCR-ABL transcripts? (6) How should response or failure be defined? (7) For the patient deemed to have failed imatinib, should one offer dasatinib or nilotinib? (8) For the patient who has failed imatinib but has a possible allogeneic transplant donor, should one offer dasatinib or nilotinib before recommending a transplant? (9) Should the transplant be myeloablative or reduced intensity conditioning? and (10) How should one treat the patient who relapses after allografting? This paper will address these issues, many of which cannot yet be answered definitively.
