NCCN Guidelines for Patients
: Chronic Myelogenous Leukemia
4.1 Tyrosine kinase inhibitor therapy
nhibitor) therapy is a type of
targeted therapy used to treat CML. Targeted therapy
is treatment with drugs that target a specific or unique
feature of cancer cells not generally present in normal
cells. Because these drugs specifically target cancer
cells, they may be less likely to harm normal cells
throughout your body.
TKIs target the abnormal BCR-ABL protein that causes
the overgrowth of abnormal white blood cells (CML cells).
The BCR-ABL protein, made by the
is a type of protein called a tyrosine kinase. Tyrosine
kinases are proteins located on or near the surface of
cells and they tell cells when to grow and divide to make
new cells. TKIs block (inhibit) the BCR-ABL protein from
sending the signals that cause too many abnormal white
blood cells to form. However, each TKI works in a slightly
The FDA (
the first TKI for the treatment of CML in 2001. Since
then, several new TKIs have been developed to treat
CML. These newer drugs are referred to as “second-
generation” TKIs. The TKIs used to treat CML are listed
in Table 4 and described on the following pages. These
drugs are made in the form of a pill that is swallowed.
The dose of the drug is measured in mg (
Some people with CML will have more than one
treatment. When and why treatments are given can
be hard to understand. Part 5 gives full details. Here,
the terms that describe the order of treatments are
is the main treatment used to rid
your body of cancer. TKIs are often used as primary
treatment for CML.
is the first
set of treatments given. If first-line treatment fails,
is the next treatment or set of
treatments given. This is also refered to as
since it is given after follow-up tests show
that the previous treatment failed or stopped working.
Order of treatments