Continuing Education

Continuing Education Information



Monitoring, Treatment Resistance, and Treatment Failure in CML: Breaking Barriers to Improved Outcomes

Jorge Eduardo Cortes, MD; John M. Goldman, DM, FRCP, FRCPath, FMedSci; Timothy P. Hughes, MD, MBBS – Chair

Release date: November 15, 2012

Expiration date: November 15, 2013

Expected time to complete this activity as designed: 60 minutes

Program Overview

Despite the dramatic success with tyrosine kinase inhibitors (TKIs) in most patients with chronic myeloid leukemia (CML), some patients still experience resistance or intolerance and need alternative therapies.  How to best assess response to TKI therapy, including how to define suboptimal response versus treatment failure and how monitoring should be conducted, remains controversial. Current guidelines to address these issues and aid in detecting early resistance to TKI therapy are somewhat discordant, but evolving. Strategies for overcoming imatinib resistance and preventing it are currently available, but additional options are needed. Several therapies are currently being evaluated as a means of overcoming resistance to imatinib and second-generation TKIs, including the investigational drug ponatinib (AP24534) as well as the newly approved agents omacetaxine mepesuccinate (Synribo) and bosutinib (Bosulif). Allogeneic hematopoietic stem cell transplant has also demonstrated efficacy in patients with imatinib-resistant disease. New next-generation TKIs and alternative therapies, once made available, will open new questions regarding optimal selection and sequencing. As members of a coordinated multidisciplinary care team, advanced practitioners play a key role in the evolving management of CML. Key to this process are incorporation of strategies to improve outcome by addressing nonadherence, managing side effects, and addressing other factors that can contribute to resistance. By providing education and support, advanced practitioners can assist patients in navigating their CML journey.

This article was adapted from a case-based roundtable discussion titled, Monitoring, Treatment Resistance, and Treatment Failure in Chronic Myeloid Leukemia: Breaking Barriers to Improved Outcomes and Looking Forward to a Cure, which was held in conjunction with the European School of Haematology (ESH) – International Chronic Myeloid Leukemia Foundation (iCMLf) 14th International Conference on Chronic Myeloid Leukemia: Biology and Therapy, held September 20–23, 2012, in Baltimore, MD.

Target Audience

This activity is designed for nurse practitioners, clinical nurse specialists, physician assistants, and other health care professionals who have an interest in enhancing their knowledge and understanding of the management of chronic myeloid leukemia.

Learning Objectives

Upon completion of this educational activity, participants should be able to:

  • Demonstrate appropriate management of patients with CML regarding current practice guideline recommendations for treatment response monitoring and tailoring of therapy based on responses
  • Relate causes of primary and secondary resistance, appropriate testing and monitoring for early detection of the occurrence of mutations, tailoring of therapy based on type of mutation(s), and current and emerging interventions to overcome them
  • Convey clinical findings relating to efficacy for agents undergoing investigation for overcoming the T315I mutation, including mechanisms of action, their potential role in the future treatment paradigm, and the importance of clinical trial referral for such patients
  • Demonstrate appropriate strategies for identifying and addressing patient nonadherence, TKI side effects, and drug-drug interactions, and for counseling patients on family planning


This activity is eligible for credit through November 15, 2013. After this date, this activity will expire and no further credit will be awarded.

The content of this article, Monitoring, Treatment Resistance, and Treatment Failure in CML: Breaking Barriers to Improved Outcomes, is a component of an online CNE activity accessible at this link:


Jorge Eduardo Cortes, MD, Professor of Medicine and Deputy Chair, Chief of the CML Section, Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, Texas

John M. Goldman, DM, FRCP, FRCPath, FMedSci, Senior Research Investigator, Division of Investigative Science, Imperial College, London, United Kingdom

Timothy P. Hughes, MD, MBBS, Clinical Professor, Department of Medicine, Department of Haematology, Centre for Cancer Biology, Adelaide, Australia

Faculty Perspectives by:

Patricia S. Ault, RN, FNP, Coordinator of Clinical Studies/Family Nurse Practitioner, The University of Texas, MD Anderson Cancer Center, Symptom Research Department, Houston, Texas

Mary Beth Rios, CCRP, RN, Research Nurse Manager, Department of Leukemia, MD Anderson Cancer Center, Houston, Texas 

Medical Writer: Marie Sabo Recine, MS


Accreditation Statement: MediCom Worldwide, Inc., 101 Washington Street, Morrisville, PA 19067 is approved by the California Board of Registered Nursing, Provider Number CEP11380. MediCom designates this CNE activity for 1.0 contact hour. Program Number: 12-325-290.

A statement of credit will be issued only upon receipt of a completed activity evaluation form.


As an organization accredited by the Accreditation Council for Continuing Medical Education (ACCME), Accreditation Council for Pharmacy Education (ACPE) and California State Board of Registered Nursing, MediCom Worldwide, Inc. requires everyone who is a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Accordingly, the following disclosures were made.


Dr. Jorge Cortes has received consultant fees as well as grant support related to research activities from ARIAD Pharmaceuticals, Inc., Bristol-Myers Squibb, ChemGenex Pharmaceuticals Ltd, Novartis AG, and Pfizer Inc.

Dr. John Goldman has received honoraria related to speakers’ bureau activities from Amgen Inc., ARIAD Pharmaceuticals, Inc., Bristol-Myers Squibb, and Novartis AG.

Dr. Timothy Hughes has received honoraria related to formal advisory activities and speakers’ bureau activities from ARIAD Pharmaceuticals, Inc., Bristol-Myers Squibb, and Novartis AG.

Patricia Ault has received honoraria related to speakers’ bureau activities from Bristol-Myers Squibb and Otsuka Pharmaceutical Co., Ltd.

Mary Beth Rios has disclosed no relevant financial relationships; she has disclosed her spouse/life partner has received honoraria related to speakers’ bureau activities from Prime Oncology.


The individuals listed below from MediCom Worldwide, Inc. reported the following for this activity: Joan Meyer, RN, MHA, executive director and Gene Tombler, PhD, medical director, have nothing to disclose. Gail Flores, PhD, and Marie Sabo Recine, MS, medical writers, have nothing to disclose.


In accordance with MediCom Worldwide, Inc. policy, all content is reviewed by external independent peer reviewers for balance, objectivity and commercial bias. The peer reviewers have no relevant financial relationships to disclose.


This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.


MediCom Worldwide, Inc.

This activity is supported by an unrestricted educational grant from ARIAD Pharmaceuticals, Inc.

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