NCCN Guidelines for Patients® | Chronic Myeloid Leukemia

30 NCCN Guidelines for Patients ® : Chronic Myeloid Leukemia, 2018 Monitoring schedule Guide 4 lists the schedule and tests advised by NCCN experts for monitoring. Green shows when milestones have been reached. Yellow shows when scores are of concern. Red shows scores failing milestones. The first round of testing should occur 3 months after treatment. Monitoring includes a medical history, physical exam, CBC with differential, and QPCR-IS. Based on QPCR-IS results, other tests may be done. Usual monitoring When milestones are reached, usual monitoring is advised. You will receive a medical history, physical exam, CBC with differential, and QPCR-IS. It’s also very important to keep taking your TKI. Your doctor will use the test results to plan how often monitoring is needed. If your score stays low, continue monitoring every 3 months for at least 2 years. After 2 years, monitoring may be done every 3 to 6 months if your score is low enough. After reaching MMR, your score may increase. If it increases by 1 log, QPCR-IS should be repeated in 1 to 3 months. Medicine check & mutation testing Certain scores at certain times will trigger more testing. These BCR-ABL1 scores are greater than 10% at 6 months, 1% at 12 months, and 0.1% beyond 12 months. A 1-log increase after reaching BCR-ABL1 <0.1% may also trigger more testing. If these cases, your doctor may check if one of your medicines is limiting another. This is called drug interactions. Tell your doctor if you’ve been unable to take your medicine as prescribed. There may be ways to help you stay on track. Mutation testing may also be done. After taking a TKI, CML cells may change so that the medicine doesn’t work. These changes are called mutations. There are mutations known to limit TKIs. Mutation testing looks for these mutations. 4 Chronic phase Monitoring Guide 4. Monitoring based on QPCR-IS QPCR-IS BCR-ABL1 scores 3 months 6 months 12 months Beyond 12 months >10% • Medicine check • Mutation testing • Medicine check • Mutation testing • Cytogenetics • Medicine check • Mutation testing • Cytogenetics • Medicine check • Mutation testing • Cytogenetics >1%–10% • Usual monitoring • Usual monitoring • Medicine check • Mutation testing • Medicine check • Mutation testing • Cytogenetics 0.1%–1.0% • Usual monitoring • Usual monitoring • Usual monitoring • Medicine check • Mutation testing <0.1% • Usual monitoring • Usual monitoring • Usual monitoring • Usual monitoring

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