Elifcan ALADAĞ, İbrahim Celalettin HAZNEDAROĞLU

Current perspectives for the treatment of chronic myeloid leukemia

Abstract: With an annual incidence of 1–2 in a million, Ph*(+) chronic myeloid leukemia (CML) is a clonal hematopoietic stem celldisease that makes myeloid neoplastic cells breed out of control. This BCR-ABL(+) myeloproliferative disease makes up about 15%–20%of all leukemia cases in adults. CML is seen more in males than females, with a rate of three to two. However, it does not show differencesin prevalence in terms of age. CML consists of three clinical phases. The first one is the chronic phase, defined by rising white blood celllevels and also by myeloid proliferation and bone marrow maturation. While this phase does not exhibit complications, in diagnosis,it comprises most of the patients. The second phase is the accelerated phase, which the disease progresses to if it is not treated or doesnot respond to treatment. This usually takes about 3 years. The third phase is the blastic phase. The chronic phase can still progressto the next two phases within the first 2 years, with a rate of 10%. In the following years, the possibility increases by 15%–20% eachyear. Tyrosine kinase inhibitors (TKIs) are revolutionary drugs for the management of disease course in CML. The aim of this reviewis to assess current approaches to CML patients’ follow-up and treatment with TKIs. A literature search on CML and TKIs was madein PubMed, Web of Science, and Scopus with particular focus on randomized clinical trials, recommendations, guidelines, and expertopinions. In managing CML, various treatment methods have been utilized for many decades. Prior to the development of TKIs,interferon alpha was the primary tool, which was then complemented by allogeneic hematopoietic stem cell transplantation (HSCT).HSCT was successful in slowing the disease down in the long term and curing up to 50% of patients. Then the coming of the imatinibera opened up different treatment perspectives. For the patients resistant or intolerant to imatinib, second- and third-generation TKIsare successfully used in distinct CML disease states. The survival benefits of TKIs including imatinib, nilotinib, dasatinib, bosutinib, andponatinib for CML patients are outstanding. TKI-related adverse events could impact the clinical course, especially in long-term drugadministrations. The current aim for CML disease management in the TKI era is to provide age- and sex-matched normal life durationto CML patients.

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