Review Article

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

Jorge Eduardo Cortes, MD(1). John M. Goldman, DM, FRCP, FRCPath, FMedSci(2), and Timothy P. Hughes, MD, MBBS(3); Faculty Perspectives by Patricia S. Ault, RN, FNP(1), and Mary Beth Rios, CCRP, RN(1)

From (1)The University of Texas MD Anderson Cancer Center, Houston, Texas; (2)Imperial College, London, United Kingdom; and (3)Centre for Cancer Biology, Adelaide, Australia

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.

Correspondence to: Timothy P. Hughes, MD, MBBS, Centre for Cancer Biology, SA Pathology, Haematology Department, Level 2, Frome Road, Adelaide SA 5000, Australia. E-mail:

J Adv Pract Oncol 2012;3(Suppl 1):4–20 | © 2012 Harborside Press®



Despite the dramatic success seen with tyrosine kinase inhibitors (TKIs) in most patients with chronic myeloid leukemia (CML), some patients still develop resistance or intolerance and need alternative therapies. Monitoring response to TKI therapy via hematologic, cytogenetic, and molecular analysis is a critical component of managing CML. Thus, uniform response definitions, response criteria, and monitoring recommendations have been developed to aid in early recognition of resistance to TKI therapy, allowing timely changes in management strategy. However, differences exist between these recommendations, and questions regarding how best to assess response, including how to define treatment failure and how monitoring should be conducted, remain. Several new drugs in late-stage development may help overcome resistance and provide additional options for patients with CML. As members of a coordinated multidisciplinary care team, advanced practitioners play a key role in the 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. Along with improved survival with TKI therapy, family planning has become an important aspect of patient management. By providing education and support, advanced practitioners can assist patients and their partners in navigating this challenging situation.

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