eCase - Chronic Myeloid Leukemia Treatment

Introduction

In this module, Fadi Ghassan Haddad, MD, provides an overview of the current targeted therapy treatment landscape for chronic myeloid leukemia (CML) and illustrates current evidence-based recommendations for the management of different scenarios in CML using a series of real-world cases.

Patients with CML may remain on treatment for a long time, if not indefinitely, and healthcare professionals (HCPs) need to be familiar with the indications and toxicities of the 5 approved BCR::ABL1 tyrosine kinase inhibitors (TKIs) imatinib, bosutinib, dasatinib, nilotinib, and ponatinib, as well as asciminib which is an inhibitor that specifically targets the ABL myristoyl pocket (STAMP) of the BCR::ABL1 fusion protein. This educational activity reviews the most recent clinical data available for these targeted therapies used for CML, as well as monitoring of disease and response to treatment, considerations to optimize the likelihood of treatment-free remission (TFR), and strategies for therapy sequencing to prevent the onset of treatment failure.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Several questions will be asked twice: once at the beginning of the activity and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

How many people with CML do you provide care for in a typical month?

A.
1-4
B.
5-10
C.
11-15
D.
16-20
E.
>20
F.
Not applicable

A 50-year-old woman with a history of pancreatitis and irritable bowel syndrome with diarrhea is recently diagnosed with intermediate risk, chronic-phase CML.

Which of the following drugs would you recommend for this patient?

A.
Asciminib
B.
Bosutinib
C.
Dasatinib
D.
Imatinib
E.
Ponatinib

Which of the following criteria is indicative of BCR::ABL1 TKI treatment failure according to guidelines and would cause you to recommend a switch in therapy?

A.
No hematologic response at 3 months and BCR::ABL1 is 12% at 6 months
B.
Patient has not achieved a major molecular response after 6 months of therapy
C.
Patient does not achieve a major molecular response and BCR::ABL1 is 0.1% at 12 months
D.
Patient experienced a 1-log increase in BCR::ABL1 transcript levels at last follow-up

All the following criteria are essential for deciding when to discontinue BCR::ABL1 TKI therapy in a patient with CML EXCEPT:

A.
Access to high-quality certified monitoring
B.
MR^4.5 sustained for at least 2 years
C.
Informed consent on risk of recurrence and monitoring requirements
D.
Previous treatment with at least 2 BCR::ABL1 TKIs
E.
Typical BCR::ABL1 transcripts at diagnosis

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Chronic Myeloid Leukemia: Optimizing Use of TKIs to Individualize Treatment Across the Disease Spectrum

Activity

Introduction

How many people with CML do you provide care for in a typical month?

Which of the following drugs would you recommend for this patient?

Which of the following criteria is indicative of BCR::ABL1 TKI treatment failure according to guidelines and would cause you to recommend a switch in therapy?

All the following criteria are essential for deciding when to discontinue BCR::ABL1 TKI therapy in a patient with CML EXCEPT: