title: Initial therapy for chronic myelogenous leukemia: playing the odds.
abstract: For patients with newly diagnosed CML, the life expectancy is much better than it was 5 years ago. However, with improvements in both transplant and nontransplant therapy comes controversy over optimal first-line therapy. We argue that an evidence-based analysis that weighs the likelihoods of surviving transplantation and responding to interferon should help guide selection of initial therapy. Such a strategy would aggressively triage appropriate patients to curative therapy while advising those who are unlikely to do well with transplantation to elect less toxic therapy, which still confers a survival benefit. We realize that many other factors beside the ones mentioned here affect a clinician's recommendation for initial therapy and a patient's ultimate choice. Many extenuating circumstances, coexisting medical conditions, and personal values need to be a part of the ultimate decision. However, we hope that this guideline summarizes the current evidence and offers a rational approach to help guide newly diagnosed patients.
authors.forename: S J
authors.initials: SJ
authors.lastname: Lee
authors.forename: C
authors.initials: C
authors.lastname: Anasetti
authors.forename: M M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: J H
authors.initials: JH
authors.lastname: Antin
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged
chemical_list: D016898:Interferon-alpha