System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Consensus Development Conference Journal Article Ppublish

PubMed: 40399529 DOI: 10.1007/s00277-025-06416-9

Management of chronic-phase CML in later lines: a Hong Kong consensus recommendation.

Ann Hematol 104(6):3091-3101

Authors: Carol Yuk Man Cheung, Chung Yin Ha, Bonnie Kho, Chi Kuen Lau, June Sze Man Lau, Shek Ying Lin, Vivien Wai Man Mak, Raymond Siu Ming Wong, Yok Lam Kwong

Affiliations

  • Department of Medicine, Queen Mary Hospital, Hong Kong SAR, People's Republic of China.
  • Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong SAR, People's Republic of China.
  • Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, People's Republic of China.
  • Department of Medicine, Tseung Kwan O Hospital, Hong Kong SAR, People's Republic of China.
  • Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China.
  • United Christian Hospital, Hong Kong SAR, People's Republic of China.
  • Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong SAR, People's Republic of China.
  • Sir Y.K. Pao Centre for Cancer & Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
  • Department of Medicine, Queen Mary Hospital, Hong Kong SAR, People's Republic of China.

Abstract

Chronic myeloid leukemia (CML) usually requires long-term therapy with tyrosine kinase inhibitors (TKIs). While these agents have markedly advanced the clinical management and prognosis of CML, a subset of patients experience treatment resistance or suboptimal response, necessitating multiple lines of TKI therapy. Few treatment options exist for patients who are resistant or intolerant to first- and second-line therapies. To provide guidance for the management of patients in chronic-phase failing at least two lines of treatment, a literature review followed by consensus generation from an expert panel with a modified Delphi process was conducted. This was followed by a meeting in person and subsequent online iterations for the establishment of a list of consensus guidelines. Consensus was defined as ≥ 75% of respondents selecting either 'accept completely' or 'accept with some reservation'. Overall, 17 statements were formulated covering five topics - defining treatment failure and acceptable treatment response, in terms of efficacy and intolerance; sequencing therapy to prevent disease progression and improve quality of life; managing patients with broad resistance, specific mutations, and risk of cardiovascular events; considering timing of cytogenetic or molecular response; and mitigating risk when using novel therapies and allogeneic hematopoietic stem cell transplantation. These comprehensive, evidence-based recommendations will assist clinicians in managing their patients with CML in third and later lines of treatment.

MeSH

Hematology, Therapeutics, Hematologic Diseases