Chronic myeloid leukemia: Current guidelines for diagnosis and management

Over the past two decades advances in the understanding of molecular and biological aspects of chronic myeloid leukemia (CML) have served as one of the cornerstones of progress in the management of leukemias, and more broadly of cancer in general. With the identification of the Philadelphia chromosome and its association with 95% of cases of CML and later with the possible etiologic role of the BCR-ABL fusion gene in the initiation of CML, a new chapter in the understanding of leukemogenesis was entered upon. Later with the identification of interferons as a therapeutic modality, and demonstration of their role in suppression of the malignant clone and the associated increase in survival, CML was one of the first malignancies in which biologic therapy found an established role. With advances in allogeneic bone marrow transplantation, it is hoped that more patients would be able to benefit from this curative therapy with less associated toxicity. However, a large proportion of patients are still unable to undergo an allogeneic transplant due to lack of donors and the expected toxicity. Other therapeutic modalities including new forms of interferon, new agents such as Homoharringtonine, and new techniques such as purged autologous transplant with or without immune-modulation need to be further developed and perfected. Our current challenges are to stratify CML patients, using the available risk scores in order to assign the most appropriate therapy to the individual, and to continue to improve upon the available therapies.