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KMID : 0882420150880040406
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Korean Journal of Medicine
2015 Volume.88 No. 4 p.406 ~ p.419
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Korean Guidelines for Treating Chronic Myelogenous Leukemia - The Korean Society of Hematology Chronic Myelogenous Leukemia Working Party
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Kim Dae-Young
Lee Jeong-Ok
Kim Kyoung-Ha
Kim Byung-Soo
Kim Sung-Hyun
Kim Yeo-Kyeoung
Kim Hyeoung-Joon
Kim In-Ho
Park Seon-Yang
Park Joon-Seong
Chung Joo-Sep
Cheong June-Won
Jung Chul-Won
Jo Deog-Yeon
Sohn Sang-Kyun
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Abstract
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Background/Aims: The first edition of the Korean treatment guidelines for chronic myelogenous leukemia (CML) was published in 2006. We intend to update those guidelines to include the use of next-generation tyrosine kinase inhibitors (TKIs).
Methods: New guidelines were developed in 2012 based on the results of a survey and a consensus meeting of various Korean experts, the reports of recent clinical studies, and updated guidelines from external study groups.
Results: An assessment of risk factors is strongly recommended before treating newly diagnosed chronic phase CML. Imatinib, dasatinib, and nilotinib are reimbursable in Korea as first-line treatments, and the patient’s age, comorbidities, and possible adverse events should be considered in the choice of treatment. Molecular studies are recommended for assessing treatment efficacy instead of invasive cytogenetic response evaluations, and an early response is believed to correlate with a good prognosis. Second-line TKIs can be considered for patients who fail or are intolerant of first-line therapy, pending analysis of ABL tyrosine kinase mutation status. For treating advanced stages, a combination of TKIs with cytotoxic agents and hematopoietic cell transplantation is recommended. The adverse effects of TKI therapy can be managed via dose reduction and supportive care, or switching to an alternate TKI.
Conclusions: The use of TKIs has improved the outcome of CML treatment. Treatment-free remission after discontinuing TKIs might be possible in select patients who achieve sufficient response, indicating that curative treatment for CML can be expected in the future.
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KEYWORD
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Leukemia, chronic myelogenous, Protein-tyrosine kinases, Guideline
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