Chronic Myeloid Leukemia Pathways (CML)

Regimen Options

Last Updated: 11/15/2024 See Details

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
Initial Therapy	imatinib 400 mg/day	Low	Low	NCCN Guidelines® for Chronic Myeloid Leukemia. V.1.2018. O’Brien SG, et al. N Engl J Med. 2003;348(11):994-1004. Jabbour E, et al. Blood. 2009;113(10):2154-60.
SUBSEQUENT THERAPY BASED ON BCR-ABL1 MUTATIONAL ANALYSIS AT 3, 6, OR 12 MONTH MILESTONES
NOT APPLICABLE OR UNKNOWN MUTATIONAL STATUS - Subsequent Therapy	imatinib (600-800 mg/day)	Low	Low	NCCN Guidelines® for Chronic Myeloid Leukemia. V.1.2018. O’Brien SG, et al. N Engl J Med. 2003;348(11):994-1004. Jabbour E, et al. Blood. 2009;113(10):2154-60. Jain P, et al. Lancet Haematology. V.2.3.2015;e118-e128.
	dasatinib	Low	Low	NCCN Guidelines® for Chronic Myeloid Leukemia. V.1.2018. Kantarjian H, et al. Blood. 2009;113(25):6322-29. Saglio G, et al. Cancer. 2010;116(16):3852-61. Kantarjian H, et al. N Engl J Med. 2010;362(24):2260-70.
	nilotinib	Low	Low	NCCN Guidelines® for Chronic Myeloid Leukemia. V.1.2018. Le Coutre PD, et al. J Clin Oncol. 2009;27(15S):abstr 7057. Saglio G, et al. N Engl J Med. 2010;362(24):2251-9. Hochhaus A, et al. Blood. 2013;121(18):3703-3708. Hughes TP, et al. Blood. 2014;123(9):1353-1360.
	HSCT (Hematopoietic stem cell transplantation)	Low	Low
Y253H, E255K/V, F359V/C/I - Subsequent Therapy	dasatinib	Low	Low	NCCN Guidelines® for Chronic Myeloid Leukemia. V.1.2018. Kantarjian H, et al. Blood. 2009;113(25):6322-29. Saglio G, et al. Cancer. 2010;116(16):3852-61. Kantarjian H, et al. N Engl J Med. 2010;362(24):2260-70.
	bosutinib	Low	Low	NCCN Guidelines® for Chronic Myeloid Leukemia. V.1.2018. Cortes JE, et al. Blood. 2011;118(17):4567-76. Gambacorti-Passerini C, et al. J Clin Oncol. 2010;28(15_suppl):abstr 6509. Khoury HJ, et al. Blood. 2012;119(15):3403-12.
	HSCT (Hematopoietic stem cell transplantation)	Low	Low
F317L/V/I/C, T315A - Subsequent Therapy	nilotinib	Low	Low	NCCN Guidelines® for Chronic Myeloid Leukemia. V.1.2018. Le Coutre PD, et al. J Clin Oncol. 2009;27(15S):abstr 7057. Saglio G, et al. N Engl J Med. 2010;362(24):2251-9. Hochhaus A, et al. Blood. 2013;121(18):3703-3708. Hughes TP, et al. Blood. 2014;123(9):1353-1360.
	HSCT (Hematopoietic stem cell transplantation)	Low	Low
V299L - Subsequent Therapy	nilotinib	Low	Low	NCCN Guidelines® for Chronic Myeloid Leukemia. V.1.2018. Le Coutre PD, et al. J Clin Oncol. 2009;27(15S):abstr 7057. Saglio G, et al. N Engl J Med. 2010;362(24):2251-9. Hochhaus A, et al. Blood. 2013;121(18):3703-3708. Hughes TP, et al. Blood. 2014;123(9):1353-1360.
	HSCT (Hematopoietic stem cell transplantation)	Low	Low
T315I - Initial/Subsequent Therapy	ponatinib	Low	Low	NCCN Guidelines® for Chronic Myeloid Leukemia. V.1.2018. Shamroe CL, et al. Ann Pharmacother. 2013;47(11):1540-6. Boddu P, et al. Leuk Lymphoma. 2017:1-11. Nicolini FE, et al. Cancer. 2017;123(15):2875-2880.
	HSCT (Hematopoietic stem cell transplantation)	Low	Low
AFTER FAILURE/INTOLERANCE TO 2 OR MORE TYROSINE KINASE INHIBITORS (TKIS) - Subsequent Therapy	asciminib	Low	Low	NCCN Guidelines® for Chronic Myeloid Leukemia. V.1.2018. <a Réa D et al. Blood . 2021 Nov 25;138(21):2031-2041.
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	Best Supportive Care or Clinical Trial

Initial Therapy

Evolent Pathways

imatinib 400 mg/day

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

SUBSEQUENT THERAPY BASED ON BCR-ABL1 MUTATIONAL ANALYSIS AT 3, 6, OR 12 MONTH MILESTONES

NOT APPLICABLE OR UNKNOWN MUTATIONAL STATUS - Subsequent Therapy

Evolent Pathways

imatinib (600-800 mg/day)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

dasatinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

nilotinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

HSCT (Hematopoietic stem cell transplantation)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

Y253H, E255K/V, F359V/C/I - Subsequent Therapy

Evolent Pathways

dasatinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

bosutinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

HSCT (Hematopoietic stem cell transplantation)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

F317L/V/I/C, T315A - Subsequent Therapy

Evolent Pathways

nilotinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

HSCT (Hematopoietic stem cell transplantation)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

V299L - Subsequent Therapy

Evolent Pathways

nilotinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

HSCT (Hematopoietic stem cell transplantation)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

T315I - Initial/Subsequent Therapy

Evolent Pathways

ponatinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

HSCT (Hematopoietic stem cell transplantation)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

AFTER FAILURE/INTOLERANCE TO 2 OR MORE TYROSINE KINASE INHIBITORS (TKIS) - Subsequent Therapy

Evolent Pathways

asciminib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

Pathways and Low-Value Regimens

Chronic Myeloid Leukemia Pathways (CML)