NCCN Guidelines for Patients® | Chronic Myeloid Leukemia

36 NCCN Guidelines for Patients ® : Chronic Myeloid Leukemia, 2018 5 Advanced phases Treatment Treatment Your doctor will plan your treatment based on many factors. These factors include your age and health history. Results of tests and any prior TKI treatment will also be used for planning. Accelerated phase Guide 6 lists three options for accelerated phase. The treatment goal is to stop the leukemia from progressing to blast phase. For long-term control, an HCT is needed. Clinical trial One option is to join a clinical trial. A clinical trial is a type of research that studies how safe and helpful a treatment is. Trials that assess TKIs with chemotherapy or other treatments are advised. Think about joining a clinical trial on treatment for a T315I mutation. TKI The second option is treatment with a TKI. If you were treated for chronic phase, don’t use the same TKI. If diagnosed in accelerated phase, your first treatment can be imatinib, dasatinib, or nilotinib. Treatment may also be chosen based on mutational testing results. If the TKI works, HCT is advised to keep CML in remission. Omacetaxine The third option is to receive omacetaxine. It is a chemotherapy agent. It is an option if CML progresses during two or more TKI treatments. It is also option if a T315I mutation is present. Treatment results While on treatment, testing to assess the results is needed. Tests will include a medical history, physical exam, CBC with differential, and QPCR-IS. In due time, an HCT is needed. If the leukemia worsens, read the next section for treatment of blast phase. Guide 6. Treatment for accelerated phase What are the options? • Clinical trial • TKI ◦◦ Imatinib if not received before ◦◦ Dasatinib if Y253H , E255K/V , or F359V/C/I mutations ◦◦ Nilotinib if F317L/V/I/C , T315A , or V299L mutations ◦◦ Bosutinib if E255K/V , F317L/V/I/C , F359V/C/I , T315A , or Y253H mutations ◦◦ Ponatinib if T315I mutation or no other TKI option • Omacetaxine if T315I mutation or leukemia worsens on 2 or more TKIs

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