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ELN Guidelines

European LeukemiaNet recommendations for the management of chronic myeloid leukemia 2013

Baccarani M et al. Blood 2013;122(6):872-884.

Click here to view a summary of the current ELN guidelines 

Executive Summary:

Advances in chronic myeloid leukemia treatment, particularly regarding tyrosine kinase inhibitors, mandate regular updating of concepts and management. A European LeukemiaNet expert panel reviewed prior and new studies to update recommendations made in 2009.

We recommend as initial treatment imatinib, nilotinib or dasatinib. Response is assessed with standardized real quantitative polymerase chain reaction and/or cytogenetics at 3, 6, and 12 months. BCR-ABL 1 transcript levels ≤ 10% at 3 months, < 1% at 6 months , and ≤ 0,1% from 12 months onward definde optimal response, whereas > 10% at 6 months and >1% from 12 months onward define failure, mandating a change in treatment. Similarly, partial cytogenetic response (PCyR) at 3 months and complete cytogenetic response (CCyR) from 6 months onward define optimal reponse, whereas no CyR (Philadelphia chromosome-positive [Ph+] >95%) at 3 months, less than PCyR at 6 months, and less than CCyR from 12 months onward define failure. Between optimal and failure, there is an intermediate warning zone requiring more frequent monitoring. Similar definitions are provided for response to second-line therapy. Specific recommendation are made for patients in the accelerated and blastic phases, and for allogeneic stem cell transplantation. Optimal responders should continue therapy indefinitely, with careful surveillance, or they can be enrolled in controlled studies of treatment disontinuation once a deeper molecular response is achieved.