Onkológia S1/2021

Recommendations for the management of patients with chronic myelocytic leukemia in the Slovak Republic

The situation in the treatment of chronic myelocytic leukemia (CML) has changed significantly over the last five years and requires regular updating of patient management and treatment recommendations. The majority of patients in chronic phase (CF) now have a?normal life expectancy. The patient's ?diagnostic risk status should be assessed using the new EUTOS Long Term Survival Score (ELTS). The first-line treatment is a?tyrosine kinase inhibitor (TKI). In addition to ELTS, we should take into account its contraindications and side effects when choosing TKI. It is recommended that the response should be monitored by a?quantitative polymerase chain reaction. In case of intolerance of TKI or failure to reach molecular milestones, a?change in treatment is recommended. The goal of treatment is to achieve a?stable deep molecular response (DMR). In patients with persistent DMR, the treatment discontinuation should be considered to achieve „treatment-free" remission (TFR). Based on the results of many clinical studies and the international convention of the panel of experts Europen LeukemiaNet (ELN) and the World Health Organization (WHO), the article provides an overview of diagnosis and definitions of response to treatment, treatment recommendations not only in newly diagnosed patients but also in patients resistant or intolerant to first line of treatment. Specific recommendations are being developed for patients in the advanced stages of the disease, during pregnancy and for allogeneic hematopoietic stem cell transplantation, which remains a?therapeutic option in some situations. We also provide an overview of side effects and interactions of individual TKIs.

Keywords: chronic myeloid leukemia, treatment recommendations, tyrosine kinase inhibitors, toxicity