NCCN Guidelines for Patients® | Chronic Myeloid Leukemia

28 NCCN Guidelines for Patients ® : Chronic Myeloid Leukemia, 2018 Part 4 is a treatment guide for the chronic phase of CML. It starts with explaining the risk groups used to plan treatment. Next, the first treatments recieved are listed. Then, monitoring and second-line treatment are explained. Your doctor may suggest other options based on your health and wishes. Fully discuss your options with your doctor. Risk groups Your doctor will plan your treatment based on many factors. These factors include your health history and treatment side effects. Another factor is the outlook (prognosis) of the leukemia. Scoring systems that predict prognosis have been made. Such systems include the Sokal and Hasford scores. Using one of these, your doctor will calculate your risk score. The score is based on your age, spleen size, and blood counts. Based on the risk score, you will be assigned to the low-, intermediate-, or high-risk group. People in the same risk group will likely respond to treatment in the same way. Thus, doctors often use risk groups to help plan treatment. Ask your doctor how your risk group affects your treatment. First-line treatment In general, there are two main goals of treatment. One goal is to control the leukemia so tests don’t detect any signs of the disease. The other goal is to stop CML from progressing to an advanced phase. Guide 3 lists first-line treatment options for the chronic phase. TKIs top the list. They are often very good at controlling CML for long periods of time. Research suggests that dasatinib and nilotinib may work better for intermediate- or high-risk groups. 4 Chronic phase Risk groups | First-line treatment Guide 3. First-line treatment What are the options? • Imatinib • Dasatinib or nilotinib • Clinical trial Sokal and Hasford risk scores † † Low-risk group • Sokal score is less than 0.8 • Hasford score is 780 or less † † Intermediate-risk group • Sokal score is between 0.8 and 1.2 • Hasford score is between 781 and 1480 † † High-risk group • Sokal score is greater than 1.2 • Hasford score is greater than 1480

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