The use of tyrosine kinase inhibitors in the second line treatment of patients with chronic myeloid leukemia

Abstract

Due to its high efficacy, imatinib (IM) has become the treatment of choice for patients with chronic myeloid leukemia (CML). However, there is still a substantial group of patients who need higher doses of IM or alternative therapy. The resistance to IM led to development of 2nd generation tyrosine kinase inhibitors (TKI). Higher doses of IM or 2nd generation TKI are used to overcome the resistance to therapy. There are several factors that need to be considered in the treatment choice decision making process in IM-resistant patients, who failed or achieved only suboptimal response, such as compliance and the type of underlying mechanism of resistance. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is used currently as subsequent treatment line in patients who failed therapy with 2nd generation TKI and progressed to accelerated or blastic phase of CML as well as in patients carrying the T315I mutation.
Hematologia 2010; 1, 3: 229-238