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Real-world Management of CML: Outcomes and Treatment Patterns

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Abstract

Purpose of Review

Chronic myeloid leukemia (CML) is a disease that previously signified a poor prognosis, but treatment options and outcomes have improved over the last several decades. Despite this, challenges remain in optimal management in clinical practice, as the characteristics in trial populations differ from patients who are treated in a real-world setting. This review describes recent updates in real-world treatment patterns and outcomes in patients with CML.

Recent Findings

Several analyses describing real-world practice patterns show that tyrosine kinase inhibitors (TKIs) are the most commonly prescribed agents in multiple lines of therapy. First-generation (1G) and second-generation (2G) TKIs are the most commonly prescribed, even in the third line and beyond. Third-generation (3G) TKIs are typically utilized in patients with resistant disease who are younger with fewer comorbidities. Hematopoietic stem cell transplant (HSCT) is utilized significantly less, given other treatment options available. The goals of treatment with CML have shifted to quality of life, cost savings, and treatment-free response (TFR). Despite clear guidelines for attempting TFR, discontinuation practice patterns remain inconsistent.

Summary

TKIs are the mainstay of CML treatment, including those in later lines of therapy. In real-world practice, several challenges still remain with regard to optimal management. Specifically, ideal sequencing of treatments, side effect profiles of tyrosine kinase inhibitors (TKIs), current role and timing of transplant, and adherence to recommendations for attempting to achieve a treatment-free response (TFR). A national registry could characterize these practice patterns in order to find ways to optimize care for CML patients.

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  1. Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Nicole Held & Ehab L. Atallah

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  1. Nicole Held
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  2. Ehab L. Atallah
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Correspondence to Ehab L. Atallah.

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No funding was received to assist with the preparation of this manuscript. Author Held has no conflicts of interest to disclose. Author Atallah has the following financial interests to declare: research support from Novartis, Abbvie, and Takeda. Author Atallah has the following non-financial interests to declare: consultancy for Novartis and Abbvie and Speakers Bureau for Abbvie and BMS.

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Held, N., Atallah, E.L. Real-world Management of CML: Outcomes and Treatment Patterns. Curr Hematol Malig Rep 18, 167–175 (2023). https://doi.org/10.1007/s11899-023-00703-w

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