CML Accelerated Phase: Treatment When Initial TKI Therapy Fails to Achieve Optimal Response

Chronic myeloid leukemia (CML) can present in or progress to an accelerated phase (AP) — a more advanced disease stage that requires a reassessment of the treatment approach, particularly when the initial therapy has not met its response goals.

Clinical scenario

CML can be classified into three phases: chronic phase (CP), accelerated phase (AP), and blast phase (BP). This protocol addresses patients in the accelerated phase — a population in whom treatment decisions are guided by the extent and speed of response to therapy.

When the previous treatment did not work

Frontline therapy in CML-AP involves a newer-generation TKI (with dasatinib or ponatinib preferred over imatinib), continued indefinitely when an optimal response is achieved. This protocol applies when that goal is not reached — specifically when complete cytogenetic response (CCyR) and BCR::ABL1 transcripts (IS) below 1% are not achieved within 6 months of initial TKI therapy.

Next-step treatment approach

When optimal response is not achieved on initial therapy, a different generation of TKI is involved in the subsequent approach, and allogeneic transplantation is part of the strategy — to be considered early based on treatment response.

Full regimen, sequencing, and transplant criteria available in the complete protocol ↓

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1002/ajh.27443

CML can be classified into three phases: CP, accelerated phase (AP), and blast phase (BP).

All other patients in CML-AP are treated with second/third generation TKI followed by allo-HSCT.

Allo-HSCT should be considered early in patients in AP based on response to TKI therapy.

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