Molecular monitoring and minimal residual disease in the management of chronic myelogenous leukemia

Abstract

The introduction of BCR-ABL1 tyrosine kinase inhibitors (TKIs) in 2001 for treatment of chronic myelogenous leukemia (CML) marked a paradigm shift in management of the disease. With that advance, CML has been largely managed as a chronic condition, with daily medication and frequent monitoring. Optimizing monitoring methods and identifying factors associated with response and long-Term outcomes has thus been a major clinical research focus. Given the improved understanding of surveillance techniques in CML and the advent of several recently approved second-and third-generation TKIs, there have been recent updates to clinical practice guidelines. The dramatic change in survival for patients with CML treated with TKIs compared with previous therapies and the subsequent incremental therapeutic improvements have led to uniquely well-supported approaches and surveillance of patients on TKI therapy. Measurement of RNA for BCR-ABL1 via quantitative PCR (qPCR) is the cornerstone of disease management. Efforts to maximize utility and scheduling of molecular monitoring and the care plans based on results of that monitoring are at the heart of current investigations. Study designs of major clinical studies in CML will incorporate new goals of therapy and molecular monitoring methods.