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Team Quality Care in CML

CE / CME

Essentials to Deliver Quality Care for Patients With CML: A Team Approach

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit™

Nurses: 1.00 Nursing contact hour

Released: March 01, 2022

Expiration: February 28, 2023

CME/CE Information

Activity

Progress
1
Course Completed

In this module, Jorge Cortes, MD, offers an overview of the current strategies used in the management of patients with chronic myeloid leukemia using targeted therapies.

Because patients with CML will likely remain on treatment for a long time, if not indefinitely, healthcare professionals (HCPs) need to be familiar with the indications and toxicities of the 5 anti–BCR-ABL1 tyrosine kinase inhibitors (TKIs)—bosutinib, dasatinib, imatinib, nilotinib, and ponatinib—and 1 inhibitor specifically targeting the ABL myristoyl pocket (STAMP) of the BCR-ABL1 fusion protein. This educational activity reviews the most recent clinical data for agents used as frontline therapy for CML, monitoring of disease and response to treatment, considerations for treatment discontinuation, strategies following frontline treatment failure, management of treatment-related toxicities, patient communication strategies, and supportive care considerations for members of the multidisciplinary team.

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.

If you are a practicing HCP, how many patients with CML do you provide care for in a typical month?

David is a 65-year-old man recently diagnosed with CML in chronic phase. He has been receiving frontline treatment with imatinib 400 mg daily for 6 months and is tolerating the medication well.

Which of the following findings would cause you to recommend a change in therapy for this patient?

A 56-year-old man presents with fatigue, night sweats, increasing abdominal fullness, and bloating. A physical examination reveals somewhat large splenomegaly approximately 9 cm below the costal margin. His comorbidities include hypertension and type 2 diabetes. A complete blood count revealed an elevated white blood cell count of 278,000/μL, hematocrit 38%, and platelets elevated at 725,000/μL. His Sokal score is 0.84 and the Hasford score is 704.39. A standard bone marrow aspiration shows hypercellularity and 2% blasts. A subsequent cytogenetic analysis shows the Philadelphia (Ph) chromosome—the well-known balanced translocation between chromosomes 9 and 22—in all 20 assessed cells: 46 XY, t(9;22)(q34;q11.2). In addition, polymerase chain reaction (PCR) analysis shows BCR-ABL1 mRNA in 94.2% of cells.

In your current practice, which of the following targeted therapies would you recommend for this patient?

Claudia is a 55-year-old woman diagnosed with Ph-positive chronic-phase CML. She is currently taking medication for hypertension. She was initially managed with 600 mg imatinib but exhibited progression with BCR-ABL1 >12% at 6 months. She was on bosutinib 500 mg daily but later experienced reduced quality of life due to persistent diarrhea and vomiting.

Which of the following anti–BCR-ABL1 inhibitors would you recommend for her at this time?

Maria is a 64-year-old woman with CML in chronic phase who has been receiving dasatinib for the last 2 years and is being followed at annual visits. Since her last visit, she reported the development of dry cough and shortness of breath. A chest x-ray revealed a left pleural effusion, and she undergoes a thoracentesis, which is common in patients receiving dasatinib.

In your current practice, how would you manage this patient’s dasatinib-associated toxicity?
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