Therapy for patients with chronic phase-chronic myeloid leukemia previously treated with ⩾2 tyrosine kinase inhibitors: a systematic literature review

Abstract

Background: ATP-competitive tyrosine kinase inhibitors (TKIs) are the current standard of care for patients with chronic phase-chronic myeloid leukemia (CP-CML) in the first-line and second-line (2 L) setting. Treatment after 2 L is not clearly established. Objective: The objective of this study was to summarize the available evidence to compare the efficacy and safety of interventions in the treatment of CP-CML patients who had received ⩾2 prior TKIs. Design: A systematic literature review was performed. Data source and methods: A systematic literature review (SLR) of studies published until May 2021, reporting clinical outcomes in adult patients with CP-CML who had received ⩾ 2 prior TKIs was performed. Studies were identified through the database searches via Ovid platform (Embase, MEDLINE Epub Ahead of Print, In-Process and Other Non-Indexed Citations, and Cochrane Central Register of Controlled Trials), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), bibliographic search of relevant reviews, and proceedings from the previous 3 years of the key conferences in the field of oncology. Results: Our search identified 38 relevant studies. Among the identified studies of the current third-line treatments, the major molecular response (MMR) rate for ponatinib was 19.0–66.7%, 23.3–25.5% for asciminib, 19.2% for omacetaxine, and 13.2% for bosutinib at 6 months. The complete cytogenetic response (CCyR) rate was 21.4–64.8% for ponatinib, 38.7–40.8% for asciminib, 18–24.2% for bosutinib, and 16.1% for omacetaxine at 6 months. Conclusion: The findings from current SLR demonstrated the lack of data for patients with CML treated with ⩾2 TKIs. TKIs such as asciminib, ponatinib, and bosutinib are valid options for those patients. Further research is needed to identify the best treatment option for patients with CML receiving later lines of therapy.

Investigations on Clinical Validation of mutated ANKRD36 as a Novel Molecular Biomarker for Monitoring Early Progression and Timely Therapeutic Interventions in Blast Crisis CML

“…Overall, 17% of CML patients (n = 21) progressed to either AP-CML (n = 11) or BC-CML (n = 10). A study conducted and all approved TKIs in technologically advanced countries (2,3,13). Furthermore, there was a significant difference between chronic- and advanced-phase patients concerning male-to-female ratio, hemoglobin level, WBC count, and platelet count.…”

“…A study conducted in the United States reported CML progression occurred in 8% of the total patients, 35 out of 482 (7.3%) patients progressed to AP-CML and 7 BC-CML (19). These differences in rate of CML progression might be due to more advanced patient-care options like stem cell transplantation and all approved TKIs in technologically advanced countries (2,3,13). Furthermore, there was a significant difference between chronic-and advanced-phase patients concerning male-to-female ratio, hemoglobin level, WBC count, and platelet count.…”

“…CML is the first aberrant chromosome abnormality described in a malignancy, known as the Philadelphia (Ph+) chromosome (2). The presence of Philadelphia chromosome t(9:22), which is a chromosomal reciprocal translocation between Abelson murine leukaemia (ABL) on the long arm of chromosome 9 and breakpoint cluster region (BCR) on chromosome 22, is a defining feature of CML (2,3). As a result of BCR-ABL1 fusion oncoprotein (P210) and the constitutive activity of tyrosine kinase, hematopoietic stem cells (HSC) are expanded clonally and CML is induced (4,5).…”

Clinical Validation Of ANKRD36 Mutations As A Novel Biomarker For Monitoring Early Progression and Timely Clinical Interventions In Blast Crisis CML

“…CML is the first aberrant chromosome abnormality described in a malignancy, known as the Philadelphia (Ph+) chromosome (2). The presence of Philadelphia chromosome t (9:22), which is a chromosomal reciprocal translocation between Abelson murine leukaemia (ABL) on the long arm of chromosome 9 and breakpoint cluster region (BCR) on chromosome 22, is a defining feature of CML (2,3). As a result of BCR-ABL1 fusion oncoprotein (P210) and the constitutive activity of tyrosine kinase, hematopoietic stem cells (HSC) are expanded clonally and CML is induced (4,5).…”