title: Chronic myeloid leukemia: an update of concepts and management recommendations of European LeukemiaNet.
abstract: OBJECTIVE
  To review and update the European LeukemiaNet (ELN) recommendations for the management of chronic myeloid leukemia with imatinib and second-generation tyrosine kinase inhibitors (TKIs), including monitoring, response definition, and first- and second-line therapy.
  
  
  METHODS
  These recommendations are based on a critical and comprehensive review of the relevant papers up to February 2009 and the results of four consensus conferences held by the panel of experts appointed by ELN in 2008.
  
  
  RESULTS
  Cytogenetic monitoring was required at 3, 6, 12, and 18 months. Molecular monitoring was required every 3 months. On the basis of the degree and the timing of hematologic, cytogenetic, and molecular results, the response to first-line imatinib was defined as optimal, suboptimal, or failure, and the response to second-generation TKIs was defined as suboptimal or failure.
  
  
  CONCLUSIONS
  Initial treatment was confirmed as imatinib 400 mg daily. Imatinib should be continued indefinitely in optimal responders. Suboptimal responders may continue on imatinb, at the same or higher dose, or may be eligible for investigational therapy with second-generation TKIs. In instances of imatinib failure, second-generation TKIs are recommended, followed by allogeneic hematopoietic stem-cell transplantation only in instances of failure and, sometimes, suboptimal response, depending on transplantation risk.
authors.affiliation: Department of Hematology/Oncology, L. and A. Seràgnoli, University of Bologna, Bologna, Italy. michele.baccarani@unibo.it
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Jorge
authors.initials: J
authors.lastname: Cortes
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pane
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Saglio
authors.forename: Jane
authors.initials: J
authors.lastname: Apperley
authors.forename: Francisco
authors.initials: F
authors.lastname: Cervantes
authors.forename: Michael
authors.initials: M
authors.lastname: Deininger
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
authors.forename: François
authors.initials: F
authors.lastname: Guilhot
authors.forename: Andreas
authors.initials: A
authors.lastname: Hochhaus
authors.forename: Mary
authors.initials: M
authors.lastname: Horowitz
authors.forename: Timothy
authors.initials: T
authors.lastname: Hughes
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.forename: Richard
authors.initials: R
authors.lastname: Larson
authors.forename: Jerald
authors.initials: J
authors.lastname: Radich
authors.forename: Bengt
authors.initials: B
authors.lastname: Simonsson
authors.forename: Richard T
authors.initials: RT
authors.lastname: Silver
authors.forename: John
authors.initials: J
authors.lastname: Goldman
authors.forename: Rudiger
authors.initials: R
authors.lastname: Hehlmann
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001549:Benzamides; D000069439:Dasatinib; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005060:Europe; D015973:Gene Expression Regulation, Leukemic; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics; D010879:Piperazines / Q000627:therapeutic use; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use; D013997:Time Factors; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D013844:Thiazoles; D000068877:Imatinib Mesylate; C498826:nilotinib; D000069439:Dasatinib