Treatment considerations

Expectations in CML treatment are evolving2
The value of achieving molecular milestones
In today’s treatment of CML, CCyR remains a satisfactory and acceptable response; however, increasing emphasis has been placed on achieving MMR as well as molecular responses beyond MMR2
Early molecular response may impact future outcomes4
It has been shown that patients with BCR-ABL1 ≤10% at 3 and 6 months may achieve better outcomes (OS, PFS, CCyR)*
Patients reaching MMR and responses beyond MMR may be more likely to achieve improved long-term clinical outcomes5
Reaching MMR, MR4, and MR4.5 are important milestones for patients, as they may minimize the risk of loss of CCyR or MMR*
*Bosutinib was not included in the study.
Considering comorbidities is important throughout CML treatment6
The increase in comorbidities with age underscores the importance of adverse reaction profiles when prescribing CML treatment3,6
Adapted from Jabbour, 2015.
Bosutinib was not included in the study.
A real-world analysis in which 2296 patients who had CML and initiated TKI treatment were identified from the MarketScan® Commercial and Medicare Supplemental databases (January 1, 2006, to June 30, 2013). Demographics and prevalence of comorbid conditions relevant to TKI treatment choice per NCCN Guidelines® (heart disease, arrhythmia, diabetes, pancreatitis, pleural effusion, lung disease) were assessed among the overall study population and among subgroups.
§Mean age in this study was 56 years old.
BCR-ABL=breakpoint cluster region-Abelson; CCyR=complete cytogenetic response; MMR=major molecular response; MR=molecular response; NCCN=National Comprehensive Cancer Network; OS=overall survival; PFS=progression-free survival; Ph+=Philadelphia chromosome–positive; TKI=tyrosine kinase inhibitor.
References
1.
BOSULIF Prescribing Information. New York, NY: Pfizer Inc.
2.
Cortes JE, Gambacorti-Passerini C, Deininger MW, et al. Bosutinib versus imatinib for newly diagnosed chronic myeloid leukemia: results from the randomized BFORE trial. J Clin Oncol. 2018;36(3):231-237.
3.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Chronic Myeloid Leukemia V.3.2020. © National Comprehensive Cancer Network, Inc. 2020. All rights reserved. Accessed April 8, 2020. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content or its use or application and disclaims any responsibility for its use or application in any way.
4.
Marin D, Ibrahim AR, Lucas C, et al. Assessment of BCR-ABL1 transcript levels at 3 months is the only requirement for predicting outcome for patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors. J Clin Oncol. 2012;30(3):232-238.
5.
Falchi L, Kantarjian HM, Wang X, et al. Significance of deeper molecular responses in patients with chronic myeloid leukemia in early chronic phase treated with tyrosine kinase inhibitors. Am J Hematol. 2013;88(12):1024-1029.
6.
Jabbour E, Makenbaeva D, Linghor-Smith M, Lin J. Use of real-world claim databases to assess prevalence of comorbid conditions relevant to the treatment of chronic myelogenous leukemia based on National Comprehensive Network treatment guidelines. Clin Lymphoma Myeloma Leuk. 2015;15(12):797-802.