NCCN Guidelines for Patients® | Chronic Myeloid Leukemia

37 NCCN Guidelines for Patients ® : Chronic Myeloid Leukemia, 2018 5 Advanced phases Treatment Blast phase CML in the blast phase can act like an acute leukemia. Acute leukemias include ALL and AML. Your treatment will be based on whether the leukemia cells are mostly lymphoid or myeloid. Guide 7 lists the options for blast phase. Options are based on the main cell type. 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 for advanced phases are advised in general. Recent trials are assessing TKIs with chemotherapy or other treatments. There may be 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. Guide 7. Treatment for blast phase Main cell type What are the options? Lymphoid • Clinical trial • TKI + ALL-type chemotherapy ◦◦ 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 • TKI + steroid Myeloid • Clinical trial • TKI + AML-type chemotherapy ◦◦ 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 • TKI alone

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