Management of chronic myeloid leukaemia (CML) has recently undergone dramatic changes, prompting the European LeukemiaNet (ELN) to issue recommendations in 2013. However, it remains unclear whether real-world CML management is consistent with these goals.
An article published in the British Journal of Haematology reports the results of UK TARGET CML, a retrospective observational study of 257 patients with chronic-phase CML who had been prescribed a first-line tyrosine kinase inhibitors (TKI) between 2013 and 2017, most of whom received first-line imatinib (n=203).
Although 44 per cent of patients required at least one change of TKI, these real-world data revealed that molecular assessments were frequently missed. Almost one in four (23%) patients with ELN-defined treatment failure did not switch TKI, and kinase domain mutation analysis was performed in only 49 per cent of patients who switched TKI for resistance.
Major molecular response (MMR; BCR-ABL1IS ≤0.1%) and deep molecular response (DMR; BCR-ABL1IS ≤0.01%) were observed in 50 per cent and 29 per cent, respectively, of patients treated with first-line imatinib and 63 per cent and 54 per cent, respectively, of those receiving a second-generation TKI first line.
MMR and DMR were also observed in 77 per cent and 44 per cent, respectively, of evaluable patients with ≥13 months follow-up receiving a second-generation TKI second line.
The authors found little evidence that cardiovascular risk factors were considered during TKI management. They say the findings highlight key areas for improvement in providing optimal care to patients with CML.