Frontline therapy

Chronic myeloid leukemia (CML) is a disease in which outstanding discoveries and achievements have been made over the past 2 decades. The use of targeted BCR-ABL protein tyrosine kinase inhibitors (TKI) has revolutionized the treatment of this disease and drastically improved its outcomes. Imatinib was the first TKI to be studied and results from the initial IRIS study continues to show major improvement over the historical interferon treatment. More recently, randomized control trials have shown that second-generation TKI's, such as dasatinib and nilotinib are superior to imatinib, with higher rates of remission, faster responses, and more robust responses to treatment. The focus in CML research has more recently shifted to achieving faster and deeper responses, these parameters being surrogate for long-term outcomes, as well as to try to achieve the deepest levels of response in hope for disease eradication. The purpose of this chapter is to review the data available on different TKIs and the different modalities in the treatment of newly diagnosed patients with CML.