An Update on the Management of Advanced Phase Chronic Myeloid Leukemia

Authors

Nicholas J Short
Jayastu Senapati
Elias Jabbour

Publication Date

12-1-2023

Journal

Current Hematologic Malignancy Reports

Abstract

Purpose of review: While most patients with chronic myeloid leukemia (CML) present in a chronic phase and are expected to have a normal life expectancy, some patients present with or progress to a more aggressive accelerated phase (AP) or blast phase (BP) of CML. Herein, we discuss the diagnostic considerations of advanced phase CML and review its contemporary management.

Recent findings: Later-generation, more potent BCR::ABL1 tyrosine kinase inhibitors (TKIs) such as ponatinib may result in superior outcomes in patients with advanced phase CML. For CML-BP, combination approaches directed against the blast immunophenotype appear superior to TKI monotherapy. The role of allogeneic stem cell transplantation is controversial in CML-AP but has consistently been shown to improve outcomes for patients with CML-BP. Advanced phase CML, particularly CML-BP, remains a poor risk subtype of CML. However, novel combination approaches using later-generation TKIs are being explored in clinical trials and may lead to improved outcomes.

Keywords

Humans, Protein Kinase Inhibitors, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Blast Crisis, Hematopoietic Stem Cell Transplantation, Fusion Proteins, bcr-abl, Drug Resistance, Neoplasm, Accelerated phase CML, BCR::ABL1, Blast phase CML, Chronic myeloid leukemia, Philadelphia chromosome, Ponatinib.

DOI

10.1007/s11899-023-00709-4

PMID

37651057

PMCID

PMC11804795

PubMedCentral® Posted Date

2-7-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes