Critical appraisal of European LeukemiaNet (ELN) 2013 recommendations for the management of chronic myeloid leukemia: is it early for a warning?

Comment and response to: the significance of early warning in chronic myeloid leukemia

“…As the authors concluded, our findings together with the current data available indicate that achieving CCyR at 12 months is most probably one of the strongest determinants of favorable long-term outcome in terms of survival [1]. And no study yet demonstrated a survival benefit of switching to another TKI in patients with a WR at 12 months, whereas this maneuver may result in achieving deeper molecular responses among this subgroup of patients [1,2].…”

“…Comment and response to: the significance of early warning in chronic myeloid leukemia We read with interest the correspondence by Mario Tiribelli and colleagues [1] about our recent paper regarding the clinical significance of 'warning' signs (especially on the long-term outcomes) in patients with chronic myeloid leukemia (CML) receiving upfront tyrosine kinase inhibitor (TKI) treatment according to the European LeukemiaNet (ELN) 2013 recommendations [2]. We thank the authors for their gentle comments on this work.…”

“…We fully agree with the authors that the ELN 2013 definitions of 'warning' signs at third and sixth months of frontline TKI therapy consider both cytogenetic and molecular response status. On the other hand, only the degree of molecular response is considered to define a warning response at 12 months [2]. So if we combine these two response categories together, in a subset of patients there can be discordant results between the cytogenetic and molecular responses at these time points, and as the authors stated, among their cohort these patients were 9.3% and 11.6% of the entire cohort at 3 and 6 months, respectively [3].…”

Evaluation of Molecular Response to Imatinib Mesylate Treatment in Iranian Patients With Chronic Myeloid Leukemia

“…7 Because the second-and third-generation TKIs drugs are more potent than imatinib and were approved for imatinib-resistant cases, obtaining an optimal response to treatment is a useful prognostic factor in planning for treatment, and the above-mentioned definitions are useful for this purpose. 1,[10][11][12][13][14][15][16][17] Several studies have demonstrated that the BCR-ABL1 transcript levels at 3 and 6 months after starting imatinib have prognostic significance and can predict PFS and OS in patients with CML. Therefore, the BCR-ABL1 transcript level at 3 and 6 months after starting imatinib is used as a predictive marker.…”

Decreased expression of microRNA‑214 contributes to imatinib mesylate resistance of chronic myeloid leukemia patients by upregulating ABCB1 gene expression

“…With the use of IM, CML-CP patients have achieved a survival rate longer than 5 years and it is predicted that their life span is close to or equivalent to that of non-leukemia patients (2,6–8). In the course of long-term follow-up of CML, some patients are found to be resistant to IM (9).…”