NCCN Guidelines for Patients® Version Updates: Chronic Myelogenous Leukemia

Following are the major updates that were included in the NCCN Guidelines for Patients®: Chronic Myelogenous Leukemia, Version 1.2014.

  • Part 3.2 – Accelerated phase
    • Page 23
      • Changed format of Table 2. Criteria for accelerated phase
      • Removed "Sokal criteria" and "International bone marrow transplant registry criteria" from Table 2
  • Part 5.1 – Initial testing
    • Page 45
      • Changed "QPCR" to "QPCR using the International Scale"
      • For FISH, added "if bone marrow can't be collected"
      • Added "Determine risk score"
  • Part 5.3.1 – Treatment response and relapse criteria
    • Page 48
      • Changed chart format
      • Removed "partial hematologic response" from chart
      • For molecular response, changed "QPCR" to "QPCR using the International Scale"
      • For major molecular response, changed criteria to "at least a 3-log reduction in BCR-ABL levels, or BCR-ABL 0.1%, found by QPCR using the International Scale"
      • Added relapse criteria to chart
  • Part 5.3.2 – Recommended follow-up testing schedule for TKI therapy
    • Page 50
      • Completely changed format of chart and test details and recommendations included in chart
      • For bone marrow cytogenetics, added that it is recommended "at any scheduled follow-up after starting treatment if QPCR using the International Scale is not available to assess treatment response"
      • Changed "QPCR" to "QPCR using the International Scale"
  • Part 5.3 – Follow-up tests and treatment responses
    • Page 53
      • Added chart explaining the International Scale for QPCR
  • Part 5.4.1 – Chronic phase 3-month follow-up treatment
    • Page 55
      • Under "Test results" – changed response criteria to "BCR-ABL ≤ 10% by QPCR using the International Scale or Partial cytogenetic response on bone marrow cytogenetics" and "BCR-ABL > 10% by QPCR using the International Scale or Less than a partial cytogenetic response on bone marrow cytogenetics"
      • Under "Follow-up treatment" – Added additional options based on test results:
        • In top half of chart, added follow-up recommendations for "No relapse" and "Relapse"
        • In bottom half of chart for prior imatinib treatment, added option "Increase imatinib dose up to 800 mg as tolerated, if not candidate for other TKI"
        • In bottom half of chart for prior nilotinib or dasatinib treatment, added option "Continue same dose of nilotinib or dasatinib"
  • Part 5.4.2 – Chronic phase 6-month follow-up treatment
    • Page 58
      • Under "Test results" – changed response criteria to "BCR-ABL ≤ 10% by QPCR using the International Scale or At least a partial cytogenetic response on bone marrow cytogenetics" and "BCR-ABL > 10% by QPCR using the International Scale or Less than a partial cytogenetic response on bone marrow cytogenetics"
      • Under "Follow-up treatment" – changed options based on changes to test results criteria
      • Added note below chart stating: "These 6-month follow-up recommendations are only for patients who, at the 3-month follow-up, had BCR-ABL >10% or had less than a partial cytogenetic response."
  • Part 5.4.3 – Chronic phase 12-month follow-up treatment
    • Page 60
      • For complete cytogenetic response, under follow-up treatment, added "Monitor with QPCR every 3 months"
      • For partial cytogenetic response, under follow-up treatment:
        • Added, "Possible BCR-ABL gene mutation analysis; Talk to your doctor about taking your TKI as prescribed and all the medications you take"
        • Added option, "Switch to alternate TKI therapy other than imatinib (preferred)"
        • Added * to third option noting it is only recommended if the patient is not a candidate for alternate TKI or omacetaxine
      • For minor or no cytogenetic response, under follow-up treatment:
        • Changed first option to "Switch to alternate TKI therapy other than imatinib (preferred) + Evaluate for HSCT based on response to second-line treatment"
      • For cytogenetic relapse, under follow-up treatment:
        • Changed first option to "Switch to alternate TKI therapy other than imatinib (preferred)"
        • Added * to second option noting it is only recommended if the patient is not a candidate for alternate TKI or omacetaxine
  • Part 5.4.4 – Chronic phase 18-month follow-up treatment
    • Page 63
      • For partial cytogenetic response and cytogenetic relapse:
        • Combined into one row since the follow-up treatment recommendations are the same
        • Changed the first follow-up treatment option to "Switch to alternate TKI therapy other than imatinib (preferred) + Evaluate for HSCT based on response to second-line treatment"
  • Part 5.5.1 – Accelerated and blast phase tests
    • Page 65
      • Removed "cytochemistry" from recommended tests for accelerated phase
  • Part 5.5.2 – Accelerated phase treatment
    • Page 67
      • For "Initial treatment" options, added "Imatinib 600 mg once daily" and "Bosutinib 500 mg once daily" and "Omacetaxine" and "+ Consider HSCT based on response to TKI therapy"
      • Beneath chart, added note "It is strongly recommended that these patients are treated in specialized centers."
  • Part 5.5.3 – Blast phase treatment
    • Page 69
      • Added new column to chart for "Relapse treatment"
      • Added note beneath chart: "It is strongly recommended that these patients are treated in specialized centers."
  • Part 5.6 – Allogeneic HSCT
    • Page 71
      • Under HSCT results, changed criteria to "Complete cytogenetic response" and "Did not have a complete cytogenetic response, or had a relapse"
      • For "Complete cytogenetic response":
        • Under follow-up tests, changed "Relapse" to "Positive" and changed "No relapse" to "Negative"
        • Under follow-up treatment for "Positive" tests, added "bosutinib" and "omacetaxine"
        • Under follow-up treatment for "Negative" tests, added "Continue scheduled follow-up tests"
      • For "Did not have a complete cytogenetic response, or had a relapse":
        • Under follow-up treatment, added "bosutinib" and "omacetaxine"