CML can present across three distinct phases. The accelerated phase (CML-AP) identifies a specific patient population with defined clinical features that inform the treatment strategy outlined in this protocol.

Clinical Scenario

This protocol applies to patients with chronic myeloid leukemia in accelerated phase (CML-AP). CML can be classified into three phases: chronic phase (CP), accelerated phase (AP), and blast phase (BP). Recognition of the AP at presentation guides the initial treatment selection.

Treatment Approach

Initial management involves therapy with a tyrosine kinase inhibitor, with newer-generation agents preferred, to reduce the CML burden. The complete selection criteria, sequencing, and response-based continuation rules are detailed in the full structured regimen.

Treatment Goal

Therapy targets an optimal response within 6 months of initiating treatment.

Optimal response within 6 months

References

DOI: 10.1002/ajh.27443

CML can be classified into three phases: CP, accelerated phase (AP), and blast phase (BP).
Patients with CML-AP or CML-BP may receive initial therapy with TKIs (newer generation TKIs like dasatinib or ponatinib preferred over imatinib) to reduce the CML burden and be considered for early allo-HSCT.
Patients with de novo CML-AP are treated with frontline second-generation TKI indefinitely if an optimal response (CCyR; BCR::ABL1 transcripts [IS] <1%) is achieved within 6 months of therapy.

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Treatment of Chronic Myeloid Leukemia in Accelerated Phase

Clinical Scenario

Treatment Approach

Treatment Goal

References