Korean J Med.
2015 Apr;88(4):406-419. 10.3904/kjm.2015.88.4.406.
Korean Guidelines for Treating Chronic Myelogenous Leukemia - The Korean Society of Hematology Chronic Myelogenous Leukemia Working Party
- Affiliations
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- 1Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 2Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
- 3Department of Oncology and Hematology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
- 4Division of Oncology and Hematology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
- 5Division of Hematology and Oncology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.
- 6Department of Hematology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea.
- 7Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
- 8Department of Hematology-Oncology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea.
- 9Department of Hemato-oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
- 10Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 11Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 12Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
- 13Department of Hemato-Oncology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea. sksohn@knu.ac.kr
- KMID: 2269125
- DOI: http://doi.org/10.3904/kjm.2015.88.4.406
Abstract
- BACKGROUND/AIMS
The first edition of the Korean treatment guidelines for chronic myelogenous leukemia (CML) was published in 2006. We intend to update those guidelines to include the use of next-generation tyrosine kinase inhibitors (TKIs).
METHODS
New guidelines were developed in 2012 based on the results of a survey and a consensus meeting of various Korean experts, the reports of recent clinical studies, and updated guidelines from external study groups.
RESULTS
An assessment of risk factors is strongly recommended before treating newly diagnosed chronic phase CML. Imatinib, dasatinib, and nilotinib are reimbursable in Korea as first-line treatments, and the patient's age, comorbidities, and possible adverse events should be considered in the choice of treatment. Molecular studies are recommended for assessing treatment efficacy instead of invasive cytogenetic response evaluations, and an early response is believed to correlate with a good prognosis. Second-line TKIs can be considered for patients who fail or are intolerant of first-line therapy, pending analysis of ABL tyrosine kinase mutation status. For treating advanced stages, a combination of TKIs with cytotoxic agents and hematopoietic cell transplantation is recommended. The adverse effects of TKI therapy can be managed via dose reduction and supportive care, or switching to an alternate TKI.
CONCLUSIONS
The use of TKIs has improved the outcome of CML treatment. Treatment-free remission after discontinuing TKIs might be possible in select patients who achieve sufficient response, indicating that curative treatment for CML can be expected in the future.
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