NCCN Guidelines for Patients® | Chronic Myeloid Leukemia
32 NCCN Guidelines for Patients ® : Chronic Myeloid Leukemia, 2018 4 Chronic phase Review must have remained at ≤0.01% for 2 or more years. There must be no history of TKI resistance. If you stop, frequent monitoring is needed. This is to make sure your scores stay low. If scores increase, you will be able to start treatment early. Please note that most people who stop a TKI will relapse. Scores of concern The following scores are of concern: >10% at 3 months, >1% to 10% at 12 months, and 0.1% to 1.0% past 12 months. You may have four options. One option is to switch to another TKI. Dasatinib, nilotinib, and bosutinib may work when imatinib does not. Bosutinib may work when dasatinib and nilotinib do not. Ponatinib may work when a T315I mutation is present. It may also work when other TKIs do not. Another option may be to stay on the same dose of nilotinib or dasatinib. Your scores may reach milestones when tested next. A third option may be to increase the dose if on imatinib. Of importance, side effects can worsen with higher doses. A higher dose is not likely to be helpful if the standard dose didn’t help. The fourth option is to discuss if allogeneic HCT is right for you. You may talk with a transplant expert. HLA typing may be done. Scores failing milestones If milestones are not met or maintained, you may have two options. One option is to switch to another TKI. The other option is to discuss if HCT is right for you. You may talk with a transplant expert. Review Your doctor will plan your treatment based on many factors. First-line treatment options include imatinib, dasatinib or nilotinib, and a clinical trial. After starting treatment, testing on a regular basis is needed to check treatment results. Second-line treatment options include switching your TKI, staying on your TKI, higher-dose imatinib, and allogeneic HCT.