Here’s how readers responded to a You Make the Call question about a patient with newly diagnosed CML who lives outside of the United States.
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- If the patient has a low-risk disease, I would prefer imatinib 400 mg/day and monitor molecular and cytogenetic responses. If she fails to achieve optimal response at any given time point, I would then consider switching to second-generation TKIs if there is no non-adherence to imatinib. Because although the lady does not have any comorbidities, second-generation TKIs have many side effects that can be observed with relatively higher rates in elderly cases than young patients.
- If the patient has a high-risk CML, maybe I would go for second-generation TKIs, since in these patients choosing a second-generation TKI can be beneficial in inducing deeper and faster molecular responses.
A. Emre Eşkazan, MD
Phillip O. Periman, MD
Texas Oncology, P.A.
Imatinib is a perfectly good choice if the patient has a low Sokal risk score.
Sarit Assouline, MDCM, MSc
Jewish General Hospital
I would go with imatinib, especially if she has a low (not high risk) Sokal score.
Juan M. Alcantar, MD
Hyroxurea, interferon alpha, or cytarabine can be given.
I would prescribe imatinib as first-line treatment, if I were in the United States, too.
Eran Zimran, MD
I agree with starting nilotinib.
Adel Z. Makary, MD
I would discuss with my patient her options noting two issues:
- The chronicity of the disease and treatment is likely life-long.
- The pros and cons of imatinib versus nilotinib … I would emphasize the small difference in the likelihood of obtaining complete response (CR); still a valid option if imatinib does not induce CR.
I would prescribe what my patient is more likely to be compliant with, as she can be enthusiastic early on at time of diagnosis, but can’t maintain the treatment recommended afterward. In this case, imatinib is more likely to be the choice, as more affordable with many generics available in different countries.
Sana Al Sukhun, MD, MSc
President of Jordan Oncology Society.
Diplomat, American Board of Medical Oncology/ Hematology
Imatinib is a good choice as well. If suboptimal or even poor response in terms of molecular remission is seen, reconsideration of treatment strategy is needed.
Bernhard Lammle, MD