NCCN Guidelines for Patients® | Chronic Myeloid Leukemia

31 NCCN Guidelines for Patients ® : Chronic Myeloid Leukemia, 2018 4 Chronic phase Second-line treatment Cytogenetics Bone marrow cytogenetics show if the Philadelphia chromosome is still present. It can also show other abnormal chromosomes. It is advised if BCR-ABL1 scores are greater than 10% at 6 months and 1% at 12 months. Cytogenetics may also be done if treatment seems to have stopped working (relapse).  Second-line treatment Guide 5 lists second-line treatment options based on QPCR-IS results. Green shows when milestones have been reached. Yellow shows when scores are of concern. Red shows scores failing milestones. Milestones reached When milestones are reached, stay on your TKI. It’s very important not to stop or skip taking your medicine. Missing doses allows the leukemia cells to grow. Continue monitoring. Stopping TKI For certain people, stopping TKI treatment may be an option. Talk to your doctor if this is an option for you. You must meet certain conditions. These conditions include taking a TKI for 3 or more years. Your scores Do not to stop or skip taking your medicine. Missing doses allows the leukemia cells to grow. Guide 5. Second-line treatment based on QPCR-IS QPCR-IS BCR-ABL1 scores 3 months 6 months 12 months Beyond 12 months >10% • Switch to new TKI • Same dose of nilotinib or dasatinib • Raise imatinib dose • Discuss HCT • Switch to new TKI • Discuss HCT • Switch to new TKI • Discuss HCT • Switch to new TKI • Discuss HCT >1%–10% • Stay on TKI • Stay on TKI • Switch to new TKI • Same dose of nilotinib or dasatinib • Raise imatinib dose • Discuss HCT • Switch to new TKI • Discuss HCT 0.1%–1.0% • Stay on TKI • Stay on TKI • Stay on TKI • Switch to new TKI • Same dose of nilotinib or dasatinib • Raise imatinib dose • Discuss HCT <0.1% • Stay on TKI • Stay on TKI • Stay on TKI • Stay on TKI HCT = hemopoietic cell transplant; TKI: tyrosine kinase inhibitor

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